Risk for Suicide Attempts Assessed Using the Patient Health Questionnaire-9 Modified for Teens.

Area of Science:

• Adolescent health
• Mental health screening
• Suicide prevention

Background:

• Suicide is a critical public health issue among US youth.
• Accurate prediction of suicide attempts is essential for timely intervention.
• The Patient Health Questionnaire-9 modified for teens (PHQ-9M) is used for depression screening.

Purpose of the Study:

• To evaluate if supplemental items (10-13) of the PHQ-9M enhance suicide attempt prediction beyond the standard PHQ-9 (items 1-9).
• To compare the predictive performance of different PHQ-9M models for youth suicide attempts.

Main Methods:

• Retrospective cohort study of adolescents (12-17 years) screened between 2016-2022.
• Developed and compared three Cox regression models (CR-9, CR-13, CR-3) using PHQ-9 and PHQ-9M data.
• Evaluated models using Area Under the Receiver Operating Characteristic Curve (AUROC) and Area Under the Precision-Recall Curve (AUPRC) across 30, 90, 180, and 365-day horizons.

Main Results:

• The study included 130,028 outpatients with 272,402 PHQ-9M screenings; 549 (0.4%) had subsequent suicide attempts within a year.
• The full PHQ-9M model (CR-13) demonstrated higher predictive accuracy (AUROC: 0.80) compared to the PHQ-9 model (CR-9, AUROC: 0.77).
• Supplemental items, particularly lifetime suicide attempts (item 13), depressed mood severity (item 10), and serious suicidal ideation (item 12), were significant predictors.

Conclusions:

• Supplemental items on the PHQ-9M significantly improve the prediction of suicide attempts in adolescents compared to the PHQ-9 alone.
• The findings support the routine use of the full PHQ-9M in adolescent outpatient settings for enhanced suicide risk assessment.
• Improved prediction models can aid in identifying at-risk youth for targeted preventive interventions.