Adolescents Who Do Not Endorse Risk via the Patient Health Questionnaire Before Self-Harm or Suicide

• DOI: 10.1001/jamapsychiatry.2024.0603
• Publication Date: 2024-04-24T15:33:07Z
• Authors: Jean P. Flores; Geoffrey Kahn; Robert B. Penfold; Elizabeth A. Stuart; Brian K. Ahmedani; Arne Beck; Jennifer M. Boggs; Karen J. Coleman; Yihe G. Daida; Frances L. Lynch; Julie E. Richards; Rebecca C. Rossom; Gregory E. Simon; Holly C. Wilcox
• Keywords: Patient Health Questionnaire; Depression

Importance Given that the Patient Health Questionnaire (PHQ) item 9 is commonly used to screen for risk of self-harm and suicide, it important clinicians recognize circumstances when at-risk adolescents may go undetected. Objective To understand characteristics with a history depression who do not endorse PHQ before near-term intentional event or suicide. Design, Setting, Participants This was retrospective cohort study design using electronic health record claims data from January 2009 through September 2017. Settings included primary care mental specialty clinics across 7 integrated US systems. Included in were aged 13 17 years completed within 30 90 days Study analyzed 2022 April 2023. Exposures Demographic, diagnostic, treatment, utilization characteristics. Main Outcome(s) Measure(s) Responded “not at all” (score = 0) regarding thoughts death Results The 691 (mean [SD] age, 15.3 [1.3] years; 541 female [78.3%]) 30-day 1024 791 [77.2%]) 90-day cohort. A total 197 (29%) 330 (32%), respectively, scored 0 suicide on 30- cohorts. Adolescents seen (odds ratio [OR], 1.5; 95% CI, 1.0-2.1; P .03) older (OR, 1.2; 1.0-1.3; .02) had increased odds scoring inpatient hospitalization diagnosis twice 2.0; 1.3-3.0; .001) days. Conversely, diagnoses eating disorders significantly less likely score 0.4; 0.2-0.8; .007) Conclusions Relevance results suggest an encounter, being screened associated having death. As use becomes more widespread practice, additional research needed understanding reasons why many self-harm.