Suicidal ideation in persons with neurological conditions: prevalence, associations and validation of the PHQ-9 for suicidal ideation - 15/09/16

Doi : 10.1016/j.genhosppsych.2016.06.006

Kristianne Chelsea Altura, B.Sc. ^a,^b, Scott B. Patten, M.D., F.R.C.P.C., Ph.D. ^b,^d, Kirsten M. Fiest, Ph.D. ^c, Callie Atta, M.Sc. ^a,^b, Andrew G. Bulloch, Ph.D. ^b,^d, Nathalie Jetté, M.D., M.Sc., F.R.C.P.C. ^a,^b,^{^⁎}
^a Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 2T9, Canada
^b Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 2T9, Canada
^c Department of Internal Medicine, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
^d Department of Psychiatry and Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 2T9, Canada

^⁎Corresponding author at: Foothills Medical Centre, Department of Clinical Neurosciences, 1403 29 Street NW, Calgary, AB T2N 2T9.Foothills Medical CentreDepartment of Clinical Neurosciences1403 29 Street NWCalgaryABT2N 2T9

Abstract

Objectives

Our primary aim was to validate the Patient Health Questionnaire (PHQ)-9 as a screening tool for suicidal ideation (SI).

Methods

Persons with epilepsy (n=188), migraine (n=208), multiple sclerosis (n=151), and stroke (n=122) completed questionnaires (e.g., PHQ-9) and the structured clinical interview for DSM-IV (SCID). Logistic regression was used to examine factors associated with SI [odds ratios (ORs) with 95% confidence intervals (CIs)]. The diagnostic accuracy of the PHQ-9 in identifying SI [sensitivity (Se), specificity (Sp), positive and negative predictive value (PPV and NPV)] was validated against the SCID.

Results

The 2-week prevalence of SI ranged from 5.7% (stroke) to 12.7% (epilepsy). Factors most strongly associated with SI were depression [OR ranging from 14.6 (migraine) to 38.6 (stroke)] and anxiety [OR ranging from 8.6 (migraine) to 15.3 (epilepsy)] (see text for 95% CI). The PHQ-9 had good Se for SI in epilepsy (90%) and migraine (75.0%). PPV was poor while Sp and NPV were >90% for every condition.

Conclusions

Screening for depression and anxiety is important in view of their strong association with SI. The PHQ-9 may be considered as a screening tool for SI, although it should not be relied on solely in view of its suboptimal PPV.

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Keywords : Suicide, Mental health, Diagnostic accuracy, Epidemiology, Depression

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Vol 42

P. 22-26 - septembre 2016 Retour au numéro

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Suicidal ideation in persons with neurological conditions: prevalence, associations and validation of the PHQ-9 for suicidal ideation - 15/09/16

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