JAMA Psychiatry

How honestly do teens respond on the PHQ-9 before self-harm or suicide?

May 3, 2024

At-risk adolescents with a history of an inpatient mental health encounter, those who were older, or those being screened in primary care were less likely to admit to having thoughts of death and self-harm on Patient Health Questionnaire (PHQ) item 9 before a self-harm event or suicide death, in this retrospective cohort study. Given that PHQ item 9 is commonly used to screen for risk of self-harm and suicide, it's critical that clinicians recognize circumstances when at-risk adolescents may go undetected.

This study used EHR and claims data from January 2009 through September 2017 in primary care and mental health specialty clinics across 7 integrated U.S. health care systems. It included adolescents ages 13 to 17 years with history of depression who completed PHQ item 9 within 30 or 90 days before self-harm or suicide.

Study findings:

• The study included 691 adolescents (mean age, 15.3 years; 78.3% female) in the 30-day cohort and 1024 adolescents (mean age, 15.3 years; 77.2% female) in the 90-day cohort.
• 197 of 691 adolescents (29%) and 330 of 1,024 adolescents (32%), respectively, scored 0 before self-harm or suicide on PHQ item 9 in the 30- and 90-day cohorts.
• Adolescents seen in primary care (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.0-2.1; P=0.03) and older adolescents (OR, 1.2; 95% CI, 1.0-1.3; P=0.02) 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=0.001) 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=0.007) within 90 days.

Source:

Flores J, et al. (2024, April 24). JAMA Psychiatry. Adolescents Who Do Not Endorse Risk via the Patient Health Questionnaire Before Self-Harm or Suicide. https://pubmed.ncbi.nlm.nih.gov/38656403/