Format

Send to

Choose Destination
Depress Anxiety. 2017 Sep;34(9):794-800. doi: 10.1002/da.22623. Epub 2017 Apr 25.

Between-visit changes in suicidal ideation and risk of subsequent suicide attempt.

Author information

1
Kaiser Permanente Washington, Health Research Institute, Seattle, WA, USA.
2
Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA.
3
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
4
HealthPartners Institute, Minneapolis, MN, USA.

Abstract

BACKGROUND:

While clinicians are expected to routinely assess and address suicide risk, existing data provide little guidance regarding the significance of visit-to-visit changes in suicidal ideation.

METHODS:

Electronic health records from four large healthcare systems identified patients completing the Patient Health Questionnaire or PHQ9 at outpatient visits. For patients completing two questionnaires within 90 days, health system records and state vital records were used to identify nonfatal and fatal suicide attempts. Analyses examined how changes in PHQ9 item 9 responses between visits predicted suicide attempt or suicide death over 90 days following the second visit.

RESULTS:

Analyses included 430,701 pairs of item 9 responses for 118,696 patients. Among patients reporting thoughts of death or self-harm "nearly every day" at the first visit, risk of suicide attempt after the second visit ranged from approximately 2.0% among those reporting continued thoughts "nearly every day" down to 0.5% among those reporting a decrease to "not at all." Among those reporting thoughts of death or self-harm "not at all" at the first visit, risk of suicide attempt following the second visit ranged from approximately 0.2% among those continuing to report such thoughts "not at all" up to 1.2% among those reporting an increase to "nearly every day".

CONCLUSIONS:

Resolution of suicidal ideation between visits does imply a clinically important reduction in short-term risk, but prior suicidal ideation still implies significant residual risk. Onset of suicidal ideation between visits does not imply any special elevation compared to ongoing suicidal ideation. Risk is actually highest for patients repeatedly reporting thoughts of death or self-harm.

KEYWORDS:

diagnosis; epidemiology; injuries; poisoning; risk; suicide

PMID:
28440902
PMCID:
PMC5870867
DOI:
10.1002/da.22623
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center