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Adolescents May Not Reliably Signal Self-Harm Risk on PHQ in Primary Care Screenings
Teens with depression who were screened in primary care or who had a history of an inpatient mental health encounter had higher odds of responding “not at all” to a question about thoughts of death or self-harm on the Patient Health Questionnaire (PHQ) in the days and weeks before a self-harm event or death by suicide. Researchers reported their findings in JAMA Psychiatry.
“Given that the PHQ item 9 is commonly used to screen for risk of self-harm and suicide, it is important that clinicians recognize circumstances when at-risk adolescents may go undetected,” wrote first author Jean P. Flores, DrPH, of the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and study coauthors.
The cohort study analyzed electronic health record and claims data from January 2009 through September 2017 for adolescents aged 13 to 17 years with history of depression who completed the PHQ item 9 within 30 or 90 days before self-harm or suicide. Researchers were interested in identifying characteristics of at-risk youth who did not endorse thoughts of self-harm or suicide before such an event.
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The 30-day cohort included 691 adolescents. Among them, 197 (29%) scored 0 (“not at all”) on the PHQ item 9 before self-harm or suicide. The 90-day cohort included 1024 adolescents, of whom 330 (32%) scored 0 before self-harm or suicide.
Adolescents with a history of inpatient hospitalization and a mental health diagnosis had double the odds of scoring 0 within 30 days of a self-harm event or suicide, according to the study. Meanwhile, odds of scoring 0 within 90 days of intentional self-harm or suicide were increased among adolescents seen in primary care (researchers reported a 1.5 odds ratio) and older adolescents (1.2 odds ratio).
Adolescents with an eating disorder diagnosis, on the other hand, were significantly less likely (0.4 odds ratio) to score 0 on item 9 within 90 days of self-harm or suicide.
“As use of the PHQ becomes more widespread in practice, additional research is needed for understanding reasons why many at-risk adolescents do not endorse thoughts of death and self-harm,” researchers wrote.
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