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Articles   |    
Does Response on the PHQ-9 Depression Questionnaire Predict Subsequent Suicide Attempt or Suicide Death?
Gregory E. Simon, M.D., M.P.H.; Carolyn M. Rutter, Ph.D.; Do Peterson, M.S.; Malia Oliver, B.A.; Ursula Whiteside, Ph.D.; Belinda Operskalski, M.P.H.; Evette J. Ludman, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200587
View Author and Article Information

The authors are with the Group Health Research Institute of the Group Health Cooperative, 1730 Minor Ave., Suite 1600, Seattle, WA 98101-1448 (e-mail: simon.g@ghc.org).

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  As use of standard depression questionnaires in clinical practice increases, clinicians will frequently encounter patients reporting thoughts of death or suicide. This study examined whether responses to the Patient Health Questionnaire for depression (PHQ-9) predict subsequent suicide attempt or suicide death.

Methods  Electronic records from a large integrated health system were used to link PHQ-9 responses from outpatient visits to subsequent suicide attempts and suicide deaths. A total of 84,418 outpatients age ≥13 completed 207,265 questionnaires between 2007 and 2011. Electronic medical records, insurance claims, and death certificate data documented 709 subsequent suicide attempts and 46 suicide deaths in this sample.

Results  Cumulative risk of suicide attempt over one year increased from .4% among outpatients reporting thoughts of death or self-harm “not at all” to 4% among those reporting thoughts of death or self-harm “nearly every day.” After adjustment for age, sex, treatment history, and overall depression severity, responses to item 9 of the PHQ-9 remained a strong predictor of suicide attempt. Cumulative risk of suicide death over one year increased from .03% among those reporting thoughts of death or self-harm ideation “not at all” to .3% among those reporting such thoughts “nearly every day.” Response to item 9 remained a moderate predictor of subsequent suicide death after the same factor adjustments.

Conclusions  Response to item 9 of the PHQ-9 for depression identified outpatients at increased risk of suicide attempt or death. This excess risk emerged over several days and continued to grow for several months, indicating that suicidal ideation was an enduring vulnerability rather than a short-term crisis.

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Figure 1 Cumulative risk of suicide attempt or death among 84,418 responders to PHQ-9 item 9 in 2007–2011a

aPHQ-9, Patient Health Questionnaire for depression

Figure 2 Cumulative risk of suicide death among 84,418 responders to PHQ-9 item 9 in 2007–2011a

aPHQ-9, Patient Health Questionnaire for depression

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Table 1Results of proportional hazards models for predicting risk of suicide attempt or suicide death
Table Footer Note

a Attempts or deaths linked to Patient Health Questionnaire (PHQ-9) completed closest to event date

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Table 2Results of proportional hazards models regarding risk of suicide death
Table Footer Note

a Deaths linked to Patient Health Questionnaire (PHQ-9) completed closest to event date

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Table 3Timing of suicide attempt or suicide death according to item 9 response from most recently completed Patient Health Questionnaire (PHQ-9)
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