Depression screening alone insufficient for detecting suicide risk

Screening for depression alone did not accurately identify suicide risk in pediatric inpatient medical units, according to data presented at the American Academy of Child and Adolescent Psychiatry annual meeting.

“In 2016 the Joint Commission recommended that all medical patients be screened for suicide risk. Without specific guidance, many hospitals are screening for suicide risk using depression screening instruments,” Elizabeth C. Lanzillo, BA, of the NIH, and colleagues wrote. “The Patient Health Questionnaire for Adolescents (PHQ-A) is a commonly used depression screen that includes an item purported to measure suicidal ideation (item 9). However, studies suggest that depression screening alone may not be adequate to detect suicide risk.”

To determine if depression screening adequately detected suicide risk in pediatric inpatient medical units, researchers had 400 medical inpatients aged 10 to 21 years complete the PHQ-A, the Ask Suicide-Screening Questions (ASQ), the Suicidal Ideation Questionnaire (SIQ), and a demographics questionnaire. Participants aged 10 to 14 years completed the SIQ-Junior. Participants who scored 11 or higher on the PHQ-A were considered positive for depression and those who endorsed any ASQ items and/or scored above the SIQ/SIQ-JR cut-off score were considered positive for suicide risk.

Overall, 9.8% of participants screened positive for depression only; 4% screened positive for suicide risk only; and 9% screened positive for both depression and suicide risk.

Among participants positive for suicide risk, 37.9% did not screen positive on the PHQ-A and approximately half did not endorse item 9.

Twenty-eight percent of participants who screened negative for depression and on item 9 were considered to be at risk for suicide.

“In this sample, depression screening alone would have failed to detect over one-quarter of youth at risk for suicide,” the researchers wrote. “Although there is clear overlap between depression and suicide risk, some medical patients at risk for suicide may pass through the health care system unrecognized if depression screening is used as a proxy for identifying suicide risk.” – by Amanda Oldt

Reference:

Lanzillo EC, et al. Detecting suicide risk on pediatric inpatient medical units: Is depression screening enough? Presented at: American Academy of Child and Adolescent Psychiatry annual meeting; Oct. 23-28, 2017; Washington, D.C.

Disclosure: Lanzillo reports no relevant financial disclosures.