Limitations of Screening for Depression as a Proxy for Suicide Risk in Adult Medical Inpatients
Department of Emergency Medicine
Emergency Medicine | Mental and Social Health | Psychiatry | Psychiatry and Psychology
BACKGROUND: Medically ill hospitalized patients are at elevated risk for suicide. Hospitals that already screen for depression often use depression screening as a proxy for suicide risk screening. Extant research has indicated that screening for depression may not be sufficient to identify all patients at risk for suicide.
OBJECTIVE: The present study aims to determine the effectiveness of a depression screening tool, the Patient Health Questionnaire-9, in detecting suicide risk among adult medical inpatients.
METHODS: Participants were recruited from inpatient medical/surgical units in 4 hospitals as part of a larger validation study. Participants completed the Patient Health Questionnaire-9 and 2 suicide risk measures: the Ask Suicide-Screening Questions and the Adult Suicidal Ideation Questionnaire.
RESULTS: The sample consisted of 727 adult medical inpatients (53.4% men; 61.8% white; mean age 50.1 +/- 16.3 years). A total of 116 participants (116 of 727 [16.0%]) screened positive for suicide risk and 175 (175 of 727 [24.1%]) screened positive for depression. Of the 116 patients who screened positive for suicide risk, 36 (31.0%) screened negative for depression on the Patient Health Questionnaire-9. Of 116, 73 (62.9%) individuals who were at risk for suicide did not endorse item 9 (thoughts of harming oneself or of being better off dead) on the Patient Health Questionnaire-9.
CONCLUSION: Using depression screening tools as a proxy for suicide risk may be insufficient to detect adult medical inpatients at risk for suicide. Asking directly about suicide risk and using validated tools is necessary to effectively and efficiently screen for suicide risk in this population.
PHQ-9, depression, inpatient, medical, screening, suicide
DOI of Published Version
Mournet AM, Smith JT, Bridge JA, Boudreaux ED, Snyder DJ, Claassen CA, Jobes DA, Pao M, Horowitz LM. Limitations of Screening for Depression as a Proxy for Suicide Risk in Adult Medical Inpatients. J Acad Consult Liaison Psychiatry. 2021 Jul-Aug;62(4):413-420. doi: 10.1016/j.jaclp.2021.02.002. Epub 2021 Feb 12. PMID: 34219655; PMCID: PMC8258235. Link to article on publisher's site
Journal of the Academy of Consultation-Liaison Psychiatry
Mournet AM, Smith JT, Bridge JA, Boudreaux ED, Snyder DJ, Claassen CA, Jobes DA, Pao M, Horowitz LM. (2021). Limitations of Screening for Depression as a Proxy for Suicide Risk in Adult Medical Inpatients. UMass Chan Medical School Faculty Publications. https://doi.org/10.1016/j.jaclp.2021.02.002. Retrieved from https://escholarship.umassmed.edu/faculty_pubs/2143