medwireNews: The Patient Health Questionnaire (PHQ)-9, which screens for depressive symptoms, underestimates suicide risk in adolescents and young adults (AYA) with type 1 diabetes when compared with a validated suicide-specific measure, research shows.
Ashley Moss (University of Washington, Seattle, USA) and colleagues say their findings “suggest sole reliance on suicide-risk items on depression screeners may not be enough to reliably identify patients at risk for suicide.”
They evaluated the ability of suicide-risk items embedded within the self-reported PHQ-9 to identify the presence of suicide risk in 133 AYA with type 1 diabetes (mean age 19.6 years, 58% young women) seen in a multidisciplinary AYA Diabetes Program clinic.
“Reliable identification of [AYA] with type 1 diabetes at risk for suicide is critical given requisite access to insulin, which can be lethal when used for self-harm,” the researchers remark.
They report in Diabetes Care that, according to the PHQ-9, 13 (9.8%) participants were at risk for suicide.
However, when the cohort was assessed using the pediatric psychologist–administered Columbia-Suicide Severity Risk Survey (C-SSRS), which serves as a reference standard, 15 (11.3%) reported suicide risk.
Of the 15 participants identified as being at risk for suicide by C-SSRS, eight also screened positive on the PHQ-9. In addition, the PHQ-9 correctly identified the absence of suicide risk in 113 of 118 participants found not to be at risk by C-SSRS.
This resulted in a sensitivity of 53.3% for the PHQ-9 suicide risk item to identify people at risk, along with a specificity of 95.7%, a positive predictive value of 61.5%, and a negative predictive value of 94.2%.
The false-negative rate was 46.7% and the false-positive rate was 4.2%.
Moss et al suggest that “the PHQ-9 suicide-risk item may perform poorly because it does not directly ask about thoughts of killing oneself nor does it delineate between passive thoughts about death and self-harm ideation.”
The authors conclude: “Given mounting evidence of suicide risk in this population, clinical guidelines should explicitly recommend use of validated, suicide-specific screeners in addition to routine depression screening as a part of comprehensive medical care for this vulnerable population.”
They add: “The findings of this study also reinforce the critical role of embedded behavioral health resources as part of a multidisciplinary team to address the needs of this unique population.”
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Diabetes Care 2022; doi:10.2337/dc21-1553