CHOP, University of Pittsburgh Researchers Demonstrate Modified Health Questionnaire is Better at Predicting Suicidal Behavior Among Teens

Three questions on modified health questionnaire were more likely to predict suicidal behavior within one year of screening

PHILADELPHIA, Nov. 1, 2024 /PRNewswire/ -- Researchers from Children's Hospital of Philadelphia (CHOP) and the University of Pittsburgh (Pitt) found that supplemental questions on a routine healthcare questionnaire could predict which adolescent patients are most likely to attempt suicide. Using this data could help identify those who are most at risk of suicidal behavior. The findings were recently published by the journal JAMA Network Open.

Suicide is one of the leading causes of death among adolescents. In order to curb this disturbing trend, pediatricians have integrated screening for depression and suicidal ideation as part of routine health care for this vulnerable age group.

One method that has seen some success is the Patient Health Questionnaire–9 (PHQ-9), a widely used self-report screen for depression in adults and adolescents during outpatient visits that can identify depression. Item 9 on the PHQ-9, which measures the frequency of current suicidal ideation or thoughts of self-harm, can identify individuals at risk for suicide attempts and deaths in both adults and adolescents. However, while the risk for suicide attempts and deaths occurred more frequently with escalating suicidal ideation reported on item 9, more than one-third of those who made suicide attempts or died by suicide within 30 days of screening reported no suicidal ideation.

More recently, the World Health Organization (WHO) launched a modified version of the PHQ-9 for teens (PHQ-9M), a self-report screen for depression during pediatric primary care visits. The PHQ-9M retains the 9 core items from PHQ-9 and four supplemental items assessing depression in the past year, functional impairment, serious suicidal ideation in the past month and lifetime history of suicide attempts. In this study, researchers wanted to determine whether this additional information was better at predicting suicide risk than the original questionnaire alone.

In the study, 130,028 outpatients received a total of 272,402 PHQ-9M screenings. Among those, 549 patients (0.4%) had subsequent suicide attempts within one year following the PHQ-9M screening. According to statistical analyses, the PHQ-9M outperformed the standard PHQ-9 when predicting suicidal behavior. The adjusted hazard ratio found that the questions on lifetime suicide attempts, depressed mood severity in the past year and serious suicidal ideation in the past month were the strongest predictors of suicidal behavior.

"Our study highlights that screening for depression is necessary but not sufficient for identifying youth at risk for suicide," said senior study author David Brent, MD, distinguished professor of psychiatry and endowed chair in Suicide Studies at the University of Pittsburgh. "Screening for depression in addition to past suicidal behavior, chronicity of depression and current suicidal ideation improve the accuracy of prediction of suicide attempts over the PHQ-9."

"By integrating the results of a patient's PHQ-9M with their electronic health records, we believe there is an opportunity to further improve predictive modeling for suicidal behavior," said first study author Fuchiang (Rich) Tsui, PhD, endowed chair in Biomedical Informatics and Entrepreneurial Science at Children's Hospital of Philadelphia. "The more we can improve detection accuracy, the earlier we can design personalized intervention strategies."

This study was supported by grants 5R21MH130853 and 5P50MH115838 from the National Institute of Mental Health.

Tsui et al, "Risk for Suicide Attempts Assessed Using the Patient Health Questionnaire–9
Modified for Teens." JAMA Netw Open. 2024;7(10):e2438144. Online October 18, 2024. DOI: 10.1001/jamanetworkopen.2024.38144.

About Children's Hospital of Philadelphia: 
A non-profit, charitable organization, Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, the hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. The institution has a well-established history of providing advanced pediatric care close to home through its CHOP Care Network, which includes more than 50 primary care practices, specialty care and surgical centers, urgent care centers, and community hospital alliances throughout Pennsylvania and New Jersey, as well as the Middleman Family Pavilion and its dedicated pediatric emergency department in King of Prussia. In addition, its unique family-centered care and public service programs have brought Children's Hospital of Philadelphia recognition as a leading advocate for children and adolescents. For more information, visit https://www.chop.edu. 

About the University of Pittsburgh
From research achievements to the quality of its academic programs, the University of Pittsburgh ranks among the top U.S. public universities. With more than 500 baccalaureate and post-graduate degrees and certificate programs across five campuses, Pitt's academic excellence and student success are reflected in its ranking among the top producers of Fulbright scholars and students. The world-changing research of polio vaccine pioneer Jonas Salk and transplant surgeon Thomas Starzl, along with records set in 2018 for the number of startup companies formed and invention disclosures submitted, demonstrate how Pitt continues to be a hub for innovation. Since it was established in 1787, Pitt has worked to strengthen communities both locally and globally through social, intellectual and economic development. Working together, the trustees, faculty, staff, students and administration are dedicated to leveraging knowledge for society's gain.

Contact: Ben Leach
Children's Hospital of Philadelphia
(609) 634-7906
[email protected]

SOURCE Children's Hospital of Philadelphia