@article{ref1,
title="The PHQ-9 Item 9 based screening for suicide risk: a validation study of the Patient Health Questionnaire (PHQ)-9 Item 9 with the Columbia Suicide Severity Rating Scale (C-SSRS)",
journal="Journal of affective disorders",
year="2018",
author="Na, Peter J. and Yaramala, Satyanarayana R. and Kim, Jihoon A. and Kim, Hyelee and Goes, Fernando S. and Zandi, Peter P. and Vande Voort, Jennifer L. and Sutor, Bruce and Croarkin, Paul and Bobo, William V.",
volume="232",
number="",
pages="34-40",
abstract="BACKGROUND: Item 9 of the Patient Health Questionnaire (PHQ) evaluates passive thoughts of death or self-injury within the last two weeks, and is often used to screen depressed patients for suicide risk. We aimed to validate the PHQ-9 item 9 with a brief electronic version of the Columbia Suicide Severity Rating Scale (eC-SSRS). <br><br>METHODS: We analyzed data from 841 patients enrolled in the National Network of Depression Centers Clinical Care Registry. We performed a validation analysis of PHQ-9 item 9 for suicide risk and ideation, using the eC-SSRS as a gold standard (defined as positive response to suicidal ideation with intent to act or recent suicidal behavior). <br><br>RESULTS: Of the 841 patients, 13.4% and 41.1% were assessed as being positive for suicide risk by the eC-SSRS and PHQ-9 item 9, respectively. For the overall cohort, sensitivity was 87.6% (95%CI 80.2-92.5%), specificity was 66.1% (95%CI 62.6-69.4%), PPV was 28.6% (95%CI 24.1-33.6%), and NPV was 97.2% (95%CI 95.3-98.3%) for the PHQ-9 suicide item. These performance measures varied within subgroups defined by demographic and clinical characteristics. In addition, the validity of PHQ-9 item 9 (cutoff score of 1) with eC-SSRS-defined suicide ideation showed overall poor results. LIMITATIONS: The gold standard used in our study was a surrogate measure of suicidality based on eC-SSRS scores. <br><br>CONCLUSIONS: The results of our study suggest that item 9 of the PHQ-9 is an insufficient assessment tool for suicide risk and suicide ideation, with limited utility in certain demographic and clinical subgroups that requires further investigation.<br><br>Copyright © 2018. Published by Elsevier B.V.<p /> <p>Language: en</p>",
language="en",
issn="0165-0327",
doi="10.1016/j.jad.2018.02.045",
url="http://dx.doi.org/10.1016/j.jad.2018.02.045"
}