A Routine Way to Predict Suicide Risk

Use of depression rating scales is becoming standard in both primary and mental health specialty care. The Patient Health Questionnaire–9 (PHQ9) is the most widely used scale, with items corresponding to each of the nine major depression diagnostic criteria. These researchers have examined responses to the PHQ9 suicidal ideation item in 84,418 patients in 2007–2011 from a large health maintenance organization that routinely used the scale (207,265 questionnaires).

Electronic records, insurance claims, and death records were used to document 709 suicide attempts and 46 suicide deaths. Cumulative risk for a suicide attempt or death rose from 0.4% at 1 year for those denying ideation to 4.0% for those endorsing thoughts “nearly every day,” a significant difference (suicide death alone, 0.03% vs. 0.3%). The increased risk with greater ideation remained significant after adjustment for demographics and other confounders. Fewer than half of the attempts occurred in the first 30 days. However, individuals denying any suicidal ideation made one quarter of the attempts in the first 30 days after PHQ9 completion.