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Does Suicidal Ideation as Measured by the PHQ-9 Predict Suicide Among VA Patients?
Samantha A Louzon1, Robert Bossarte1, John F McCarthy1
1Ms. Louzon is with Branch Creative Network, Dearborn, Michigan (e-mail: sammilouzon@gmail.com ). At the time that this work was done, she was with the Office of Mental Health Operations, U.S. Department of Veterans Affairs (VA), Ann Arbor, Michigan, where Dr. McCarthy is affiliated. Dr. Bossarte is with the VA Office of Public Health and Office of Mental Health Services, Rochester, New York. Dr. Katz is with the VA Office of Mental Health Operations, Washington, D.C.
Objective:
Frequency of suicidal ideation in the past two weeks, assessed by item 9 of the nine-item Patient Health Questionnaire (PHQ-9), has been positively associated with suicide mortality among patients in a setting other than the Veterans Health Administration (VHA). To inform suicide prevention activities at the VHA, it is important to evaluate whether item 9 is associated with suicide risk among patients in the VHA system.
Methods:
PHQ-9 assessments (N=447,245) conducted by the VHA between October 1, 2009, and September 30, 2010, were collected. National Death Index data were used to ascertain suicide mortality from the date of PHQ-9 assessment through September 30, 2011. Multivariable proportional hazards regressions were used to evaluate associations between responses to item 9 and suicide mortality.
Results:
After the analyses adjusted for covariates, a response of "several days" for item 9 was associated with a 75% increased risk of suicide (hazard ratio [HR]=1.75, 95% confidence interval [CI]=1.24-2.46), a response of "more than half the days" was associated with a 115% increased risk of suicide (HR=2.15, CI=1.32-3.51), and a response of "nearly every day" was associated with a 185% increased risk of suicide (HR=2.85, CI=1.81-4.47), compared with a response of "not at all." However, 71.6% of suicides during the study period occurred among patients who responded "not at all" to item 9 from their most recent PHQ-9.
Conclusions:
Higher levels of suicidal ideation, indicated by item 9 of the PHQ-9, were associated with increased risk of suicide among patients in the VHA system.
