PHQ-9 May Be a Useful Tool for Teenage Suicide Prevention

The Patient Health Questionnaire-9 (PHQ-9) may have value as a screening tool for suicide risk as well as major depressive disorder for adolescents.

Patient Health Questionnaire-9 (PHQ-9) may have value as a screening tool for suicide risk as well as major depressive disorder (MDD) for adolescents, according to a study published in the Journal of Pediatrics.

Using data from the Screening in High Schools to Identify, Evaluate and Lower Depression (SHIELD) clinical trial, the researchers explored whether PHQ-9 helped increase identification of suicide risk and treatment initiation among high school students. The purpose was to find out the percentage of students with identified suicide risk who were referred to a Student Assistance Program (SAP).

The SHIELD study included 12,909 students: 6436 were randomly assigned to targeted screening and 6473 were randomized to universal screening. The median age of students was 16 with a range from 13 to 21 years of age.

The researchers found 5.6% of the students met the criteria for suicide risk. The students in the universal screening arm were 7.1 times more likely to be identified as a suicide risk, 7.8 times more likely of being identified as in need of follow up, and 4 times more likely to begin treatment than students in the targeted treatment arm.

Future work should aim to measure the functional improvements in students identified by school-based screenings, as well as the benefits of interventions designed to enhance treatment utilization as well as disease detection.

The pragmatic trial design meant the SHIELD study didn’t have all the constraints of a typical randomized trial. In addition, the students had other paths to care management.

Researchers stated, “universal screening in the school setting with the PHQ-9 helps to identify students at risk for suicide and increases treatment initiation. Analyses considering removal of the suicide risk question and use of the PHQ-8 demonstrated a substantial number of at-risk students would be missed.”

Although burden on school staff is a consideration, “schools that partnered with the research team were confident in their ability to manage an increased number of student referrals,” the researchers said. “The study results support the effectiveness of suicide risk screening to increase treatment initiation for identified adolescents.”

“Future work should aim to measure the functional improvements in students identified by school-based screenings, as well as the benefits of interventions designed to enhance treatment utilization as well as disease detection,” the researchers concluded.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

References:

Sekhar DL, Batra E, Schaefer EW, et al. Adolescent suicide risk screening: a secondary analysis of the SHIELD randomized clinical trialJ Pediatr. 2022;S0022-3476(22)00697-7. doi:10.1016/j.jpeds.2022.07.036