Thursday, March 14, 2019

Response to PHQ Item May Predict Suicide Risk Among Patients With Psychosis

Answers to a specific questionnaire item about thoughts of self-harm strongly predicted which patients with a psychotic disorder would attempt suicide in the next 90 days, according to a study in the March Psychiatric Services.

Suicidal behavior is especially common among individuals with psychotic disorders: 1 in 20 die by suicide and more than 1 in 4 attempt suicide at some point, wrote Gregory E. Simon, M.D., M.P.H., of the Kaiser Permanente Washington Health Research Institute, and colleagues. “Our findings indicate that individuals with psychotic disorders provide clinically useful responses to simple self-report questions about thoughts of death or self-harm.”

Researchers studied electronic health records over more than six years from seven large integrated health systems in nine states to identify adults with a diagnosis of schizophrenia spectrum psychosis, schizoaffective disorder, or unspecified psychosis. They identified all outpatient visits during which these patients completed the nine-item Patient Health Questionnaire (PHQ-9) and tracked their suicide attempts or completed suicides for 30 days and 90 day after their visits. Altogether, the study sample included 33,000 visits by nearly 6,000 patients.

More than 1 in 10 outpatients with a psychotic disorder reported frequent thoughts of death or self-harm on PHQ-9 item 9, which asks “Over the past 2 weeks, how often have you been bothered by thoughts that you would be better off dead or of hurting yourself in some way?” Researchers found that responses to Item 9 was a strong predictor of a suicide attempt over the ensuing 90 days: nearly half of suicide attempts occurred among those who reported recent thoughts of death or self-harm at the sampled visit. Also, 59% of suicide attempts occurred among those reporting thoughts of death or self-harm at the index visit or any visit in the prior year.

The risk of suicide attempt within 90 days of an outpatient visit was 0.8% among the patients reporting no thoughts of death or self-harm and 3.5% among those reporting such thoughts “nearly every day.” A similar pattern was seen for suicide attempts within 30 days of the visits. Considering patients’ prior-year responses to item 9—not just the current response—improved detection of risk, researchers said.

Researchers said identification of suicide risk should not be limited to self-report questionnaires and information typically recorded in electronic health records. “Providers should also consider important social risk factors for suicidal behavior, such as job loss, bereavement, or relationship disruption.”

Researchers noted the gap between assessment and subsequent treatment of suicidal patients: “Endorsement of frequent thoughts of death or self-harm certainly indicates an increased risk of self-harm and a need for more detailed assessment and appropriate care planning. Of patients reporting thoughts of death or self-harm nearly every day, approximately 1 in 30 received care for self-harm or probable suicide attempt during the following 90 days.”

For more information, see the Psychiatric Services study: “Predicting Suicide Attempts and Suicide Deaths Following Outpatient Visits Using Electronic Health Records.”

(Image: fizkes/


The content of Psychiatric News does not necessarily reflect the views of APA or the editors. Unless so stated, neither Psychiatric News nor APA guarantees, warrants, or endorses information or advertising in this newspaper. Clinical opinions are not peer reviewed and thus should be independently verified.