Adolescents Who Do Not Endorse Risk via the Patient Health Questionnaire Before Self-Harm or Suicide Article Swipe
Jean P. Flores
,
Geoffrey Kahn
,
Robert B. Penfold
,
Elizabeth A. Stuart
,
Brian K. Ahmedani
,
Arne Beck
,
Jennifer M. Boggs
,
Karen J. Coleman
,
Yihe G. Daida
,
Frances L. Lynch
,
Julie E. Richards
,
Rebecca C. Rossom
,
Gregory E. Simon
,
Holly C. Wilcox
·
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1001/jamapsychiatry.2024.0603
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1001/jamapsychiatry.2024.0603
Importance Given that the Patient Health Questionnaire (PHQ) item 9 is commonly used to screen for risk of self-harm and suicide, it is important that clinicians recognize circumstances when at-risk adolescents may go undetected. Objective To understand characteristics of adolescents with a history of depression who do not endorse the PHQ item 9 before a near-term intentional self-harm event or suicide. Design, Setting, and Participants This was a retrospective cohort study design using electronic health record and claims data from January 2009 through September 2017. Settings included primary care and mental health specialty clinics across 7 integrated US health care systems. Included in the study were adolescents aged 13 to 17 years with history of depression who completed the PHQ item 9 within 30 or 90 days before self-harm or suicide. Study data were analyzed September 2022 to April 2023. Exposures Demographic, diagnostic, treatment, and health care utilization characteristics. Main Outcome(s) and Measure(s) Responded “not at all” (score = 0) to PHQ item 9 regarding thoughts of death or self-harm within 30 or 90 days before self-harm or suicide. Results The study included 691 adolescents (mean [SD] age, 15.3 [1.3] years; 541 female [78.3%]) in the 30-day cohort and 1024 adolescents (mean [SD] age, 15.3 [1.3] years; 791 female [77.2%]) in the 90-day cohort. A total of 197 of 691 adolescents (29%) and 330 of 1024 adolescents (32%), respectively, scored 0 before self-harm or suicide on the PHQ item 9 in the 30- and 90-day cohorts. Adolescents seen in primary care (odds ratio [OR], 1.5; 95% CI, 1.0-2.1; P = .03) and older adolescents (OR, 1.2; 95% CI, 1.0-1.3; P = .02) had increased odds of scoring 0 within 90 days of a self-harm event or suicide, and adolescents with a history of inpatient hospitalization and a mental health diagnosis had twice the odds (OR, 2.0; 95% CI, 1.3-3.0; P = .001) of scoring 0 within 30 days. Conversely, adolescents with diagnoses of eating disorders were significantly less likely to score 0 on item 9 (OR, 0.4; 95% CI, 0.2-0.8; P = .007) within 90 days. Conclusions and Relevance Study results suggest that older age, history of an inpatient mental health encounter, or being screened in primary care were associated with at-risk adolescents being less likely to endorse having thoughts of death and self-harm on the PHQ item 9 before a self-harm event or suicide death. As use of the PHQ becomes more widespread in practice, additional research is needed for understanding reasons why many at-risk adolescents do not endorse thoughts of death and self-harm.
Related Topics
Concepts
Medicine
Patient Health Questionnaire
Cohort
Depression (economics)
Psychiatry
Suicide prevention
Occupational safety and health
Poison control
Suicide attempt
Suicidal ideation
Mental health
Cohort study
Injury prevention
Health care
Medical emergency
Depressive symptoms
Anxiety
Internal medicine
Economic growth
Economics
Pathology
Macroeconomics
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1001/jamapsychiatry.2024.0603
- OA Status
- green
- Cited By
- 11
- References
- 36
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4395071694
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4395071694Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1001/jamapsychiatry.2024.0603Digital Object Identifier
- Title
-
Adolescents Who Do Not Endorse Risk via the Patient Health Questionnaire Before Self-Harm or SuicideWork title
- Type
-
articleOpenAlex work type
- Language
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enPrimary language
- Publication year
-
2024Year of publication
- Publication date
-
2024-04-24Full publication date if available
- Authors
-
Jean P. Flores, Geoffrey Kahn, Robert B. Penfold, Elizabeth A. Stuart, Brian K. Ahmedani, Arne Beck, Jennifer M. Boggs, Karen J. Coleman, Yihe G. Daida, Frances L. Lynch, Julie E. Richards, Rebecca C. Rossom, Gregory E. Simon, Holly C. WilcoxList of authors in order
- Landing page
-
https://doi.org/10.1001/jamapsychiatry.2024.0603Publisher landing page
- Open access
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YesWhether a free full text is available
- OA status
-
greenOpen access status per OpenAlex
- OA URL
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https://www.ncbi.nlm.nih.gov/pmc/articles/11044012Direct OA link when available
- Concepts
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Medicine, Patient Health Questionnaire, Cohort, Depression (economics), Psychiatry, Suicide prevention, Occupational safety and health, Poison control, Suicide attempt, Suicidal ideation, Mental health, Cohort study, Injury prevention, Health care, Medical emergency, Depressive symptoms, Anxiety, Internal medicine, Economic growth, Economics, Pathology, MacroeconomicsTop concepts (fields/topics) attached by OpenAlex
- Cited by
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11Total citation count in OpenAlex
- Citations by year (recent)
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2025: 7, 2024: 4Per-year citation counts (last 5 years)
- References (count)
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36Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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