At-risk adolescents with depression less likely to endorse suicidal thoughts on questionnaire

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Findings from a study published in JAMA Psychiatry suggest that being screened in primary care, older age, and history of an inpatient mental health encounter were associated with at-risk adolescents being less likely to endorse having thoughts of death or self-harm on the Patient Health Questionnaire (PHQ) item 9 prior to a self-harm event or suicide death.

Investigators sought to evaluate characteristics of adolescents with a history of depression who do not endorse risk via the PHQ item 9, which is commonly used to screen for self-harm and suicide risk. The study authors noted these circumstances are important to recognize at-risk individuals who may go undetected via the questionnaire.

In a retrospective cohort study design, electronic health record and claims data from January 2009 to September 2017 were used. Primary care and mental health specialty clinics across 7 integrated health care systems in the United States were study settings.

Adolescents aged 13 to 17 years with history of depression who completed the PHQ item 9 within 30 or 90 days prior to self-harm or suicide were included in the study. The measure of the study was a response of "not at all" or score of 0, to PHQ item 9 regarding self-harm or thoughts of death in the aforementioned timeframe.

The 30-day cohort included 691 adolescents with a mean age of 15.3 years (1.3), of which 78.3% were female. There were 1024 adolescents in the 90-day cohort, which consisted of 791 females (77.2%) with a mean age of 15.3 years (1.3).

In the 30-day cohort, 29% of individuals scored 0 before self-harm or suicide on the PHQ item 9. More adolescents, 32%, in the 90-day cohort scored 0 before self-harm or suicide.

Abstract results stated that adolescents seen in primary care (odds ratio [OR] 1.5, 95% CI, 1.0-2.1 [P - .03]), as well as older adolescents (OR 1.2, 95% CI, 1.0-1.3 [P = .02]), had increased odds of scoring 0 within 90 days of self-harm or suicide.

"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," wrote the investigators. Those diagnosed with eating disorders were significantly less likely to score 0 (OR, 0.4; 95% CI, 0.2-0.8; [P = .007]).

Overall, older age, history of inpatient mental health encounters, or primary care screenings were associated with at-risk adolescents being less-likely to report having thoughts of self-harm or suicide.

The investigators concluded, "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."

Reference:

Flores JP, Kahn G, Penfold RB, et al. Adolescents who do not endorse risk via the patient health questionnaire before self-harm or suicide. JAMA Psychiatry. Published online April 24, 2024. doi:10.1001/jamapsychiatry.2024.0603