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Validating the C-PHQ-9 suicide item against the C-NDDI-E for detecting suicidal ideation in Chinese adults with
Zhengzheng Li1, Jiaoni Gong1, Yanru Du1
1Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China.
Background And Objective:
People with epilepsy (PWE) face a mortality risk from suicide that is roughly threefold higher than that of the general public; however, effective clinical screening for such risks remains a significant gap. Although depression acts as a primary indicator of suicidal ideation in this group, and while the Chinese versions of the Neurological Disorders Depression Inventory for Epilepsy (C-NDDI-E) and the Patient Health Questionnaire-9 (C-PHQ-9) are common self-report instruments, the specific diagnostic value of the C-PHQ-9's suicide-related item remains unverified in PWE. Furthermore, no direct comparative data exists. This study aimed to validate the diagnostic validity of the suicide component of the C-PHQ-9 in adult patients with epilepsy in Southeast China. The scale was validated against the MINI-SM and benchmarked against the C-NDDI-E to compare their diagnostic accuracy.
Methods:
Adult PWE were recruited from a tertiary epilepsy outpatient clinic. Assessments were conducted in a single session, where subjects first finalized the self- report scales (C-NDDI-E and C-PHQ-9) rafter undergoing the reference evaluation via the Mini-International Neuropsychiatric Interview suicide module (MINI-SM). Receiver operating characteristic (ROC) analyses were performed to assess diagnostic performance.
Results:
Among 321 participants, 45 (14.0 %) were identified as having suicidal ideation by the MINI-SM. The C-PHQ-9 suicide item showed moderate diagnostic performance (sensitivity 71.1 %, specificity 92.0 %, AUC 0.813), with an optimal cutoff of ≥1. In contrast, the C-NDDI-E suicide item demonstrated superior accuracy (sensitivity 86.7 %, specificity 90.6 %, AUC 0.891), with an optimal cutoff of ≥2. TheAUC of the C-NDDI- E item was significantly higher than that of the C-PHQ-9 item (P < 0.05).
Conclusion:
Suicidal ideation is notably prevalent among adult PWE in Southeast China. Based on comparative outcomes, the C-NDDI-E suicide item demonstrates enhanced reliability over the C-PHQ-9, making it the preferable instrument for screening this specific demographic.