JAMA Network Open: Risk for Suicide Attempts Assessed Using the Patient Health Questionnaire–9 Modified for Teens

Suicide rates among adolescents have been increasing for more than 15 years. One strategy for reversing this disturbing trend is to screen for depression and suicidal risk in the pediatric primary care setting. The Patient Health Questionnaire–9 (PHQ-9), a self-report screen for depression in adults and adolescents during outpatient visits, has been shown to effectively detect major depression. In addition, item 9 on the PHQ-9, measuring the frequency of current suicidal ideation or thoughts of self-harm, can identify individuals at risk for suicide attempts and deaths in both adults and adolescents. 

While the risk for suicide attempts and deaths increases with increased frequency of suicidal ideation reported on item 9, studies show that more than one-third of those who made suicide attempts or died by suicide within 30 days of screening reported no suicidal ideation. Similarly, the PHQ-9 used in pediatric primary care screening missed some individuals at risk for suicide who were detected with the addition of a four-item suicide risk screening. A revised PHQ-9, the PHQ-9M is modified for teens to include nine core items from the PHQ-9, as well as four additional questions assessing depression, functional impairment, and suicidality.

To address whether the PHQ-9M is better than the standard PHQ-9 at identifying youth who will make a suicide attempt, investigators at Children’s Hospital of Philadelphia (CHOP) and the University of Pittsburgh conducted a retrospective single-center cohort study funded by a National Institute of Mental Health Suicide Prevention Center grant, Enhancing Triage and Utilization for Depression and Emergent Suicidality (ETUDES). Investigators from CHOP including, F. Rich Tsui, PhD; Molly Davis, PhD; and Jami Young, PhD; in collaboration with Neal Ryan, MD (Joaquim Puig-Antich Professor in Child and Adolescent Psychiatry and Professor of Clinical and Translational Science); Nadine Melhem, PhD (Professor of Psychiatry and Associate Professor of Clinical and Translational Science); and David Brent, MD (Distinguished Professor of Psychiatry, Pediatrics, Epidemiology, and Clinical and Translational Science and Endowed Chair in Suicide Studies), from Pitt Psychiatry, assessed whether screening with supplemental items PHQ-9 modified for teens improves prediction of youth suicide attempts compared with the information provided by the PHQ-9 in a cohort of 130,028 adolescents.

The results of the study, published in JAMA Network Open, indicated that for suicide risk prediction, the clinical utility of the PHQ-9 modified for teens was superior to information gleaned from the original PHQ-9. Two of added the PHQ-9M questions, lifetime history of a suicide attempt, and intensity of depression were among the strongest predictors a future suicide attempt.

“Asking a few additional questions about suicidal risk can improve our ability to identify youth at risk for suicidal behavior and refer them for treatment that they need,” said Dr. Brent, the study’s senior author. “These questions could help to identify teens at risk for suicide that we might have previously missed, and give us the chance to save a life.” 

Risk for Suicide Attempts Assessed Using the Patient Health Questionnaire–9 Modified for Teens
Tsui F, Ruiz VM, Ryan ND, Shi L, Melhem NM, Young JF, Davis M, Gibbons R, Brent DA.
JAMA Network Open. 2024;7(10):e2438144. doi:10.1001/jamanetworkopen.2024.38144