The Patient Health Questionnaire-9 modified for teens, an adaptation of the standard depression screening tool, may enhance the prediction of suicide attempts in adolescents, according to a recent cohort study.
Researchers analyzed the addition of supplemental items 10 to 13 on the Patient Health Questionnaire-9 modified for teens (PHQ-9M) to determine if they improved prediction of suicide attempts compared to the standard 9-item PHQ-9. The study included 130,028 adolescents aged 12 to 17 who underwent PHQ-9M screenings between 2016 and 2022 in outpatient pediatric settings. Of these, 549 (0.4%) adolescents had a documented suicide attempt within one year, with a median time to the attempt of 172 days, as recorded in electronic health records.
Demographic data showed that 50.4% of participants were male, 49.6% female. Racially, 28.2% were Black, 54.4% were White, and 16.3% were from other racial groups. Hispanic/Latino adolescents made up 7.7% of the sample. Black adolescents had a higher prevalence of suicide attempts (0.55%) compared to White adolescents (0.37%), with an odds ratio of 1.48 (95% CI, 1.23-1.78). Female adolescents were also at higher risk compared to males, with an odds ratio of 3.81 (95% CI, 3.12-4.70).
The researchers evaluated three Cox proportional hazards models: the 9-item PHQ-9 (CR-9), the 13-item PHQ-9M (CR-13), and a 3-item model (CR-3) based on the most predictive items. The CR-13 model showed superior predictive accuracy, with an area under the receiver operating characteristic curve (AUROC) of 0.80, compared to 0.77 for the CR-9 and 0.79 for the CR-3. Precision-recall analysis revealed a slight advantage for CR-13, with an area under the precision recall curve (AUPRC) of 0.03 (95% CI, 0.02-0.03), compared to 0.02 for both CR-9 and CR-3.
Supplemental items most strongly associated with future suicide attempts were lifetime suicide attempts (hazard ratio [HR], 3.06; 95% CI, 2.47-3.80), depressed mood severity over the past year (HR, 2.99; 95% CI, 2.32-3.86), and serious suicidal ideation in the past month (HR, 1.63; 95% CI, 1.25-2.12). The study, published in JAMA Network Open, suggests that routine use of the PHQ-9M may improve identification of adolescents at risk for suicide attempts during outpatient visits.
Full disclosures can be found in the published study.