Accuracy of Self-Report Questionnaires and Records-Based Risk Scores to Identify Adolescents' Risk for Self-Harm

Area of Science:

• Adolescent health
• Mental health screening
• Public health surveillance

Background:

• Identifying adolescents at risk for self-harm is crucial for timely intervention.
• Current screening methods in outpatient settings require evaluation for effectiveness.

Purpose of the Study:

• To assess the efficacy of screening strategies for identifying self-harm risk in adolescents during outpatient healthcare visits.
• To evaluate the performance of the Patient Health Questionnaire-9 (PHQ-9) and health record-based risk scores.

Main Methods:

• A prospective cohort study using health system records of adolescents completing the PHQ-9.
• A retrospective cohort study of adolescents with self-harm events.
• Analysis of sensitivity and positive predictive value (PPV) of screening tools.

Main Results:

• A score of ≥2 on PHQ-9 item 9 showed a sensitivity of 0.37 and PPV of 0.09 for self-harm within 180 days.
• 89% of adolescents with self-harm had a relevant mental health or primary care visit in the preceding 180 days.
• Screening strategies could identify over 80% of adolescents experiencing self-harm.

Conclusions:

• PHQ-9 item 9 responses and health record risk scores effectively identify adolescents at risk for self-harm.
• Outpatient healthcare visits provide a critical opportunity for screening and early identification of self-harm risk.