(170) Assessing Suicidal Ideation: Augmenting the Patient Health Questionnaire-9 with the Columbia-Suicide Severity Rating Scale

Abstract:

Background:

The Patient Health Questionnaire-9 (PHQ-9) depression screening questionnaire was used by nursing staff at Maine Medical Center (MMC) to screen all medical patients for suicide risk on admission. Although the PHQ-9 is considered reliable for identifying risk for suicide attempts (Rossom et al., 2017), others have found it to be a less reliable tool (Na et al., 2017).



Methods:

We examined the current protocol of placing all patients who scored positive on PHQ-9 item 9 on high-risk suicide precautions until a psychiatric evaluation, including Columbia-Suicide Severity Rating Scale (C-SSRS), could be completed by the consultation-liaison psychiatry service.

The health system approved the pilot for additional screening of patients upon admission with C-SSRS, should they score on PHQ-9 item 9. A patient scoring high or moderate risk on C-SSRS was placed on high risk suicide precautions until evaluated by a consultation-liaison psychiatry provider. Low risk patients were not be placed on precautions. Historical data from the electronic health record was reviewed pre and post intervention. IRB determined formal approval was not required. The primary aims were increased safety, improved efficiency, and reduced resource burden.



Results:

PHQ-9 alone (6/1/2020 through 5/16/2021):

4 45 patients positive on PHQ-9 item 9

< ! 2/45 patients continued on high-risk precautions following evaluation by psychiatry

< ! 7/45 patients never evaluated by psychiatry (missed)

With addition of C-SSRS (5/17/21 through 12/1/21):

< ! 29 patients identified as positive on PHQ-9 item 9

< ! 15/29 patients identified as “low” risk on C-SSRS by nursing staff, 9/29 patients not assigned a risk level

< ! 3/29 patients determined to be high or moderate risk on nursing administered C-SSRS, 1 determined to be high risk by psychiatry

< ! 1 patient scored on PHQ-9 item 9 did not receive the C-SSRS or assessment by psychiatry (missed)



Discussion:

There was a reduction in utilization of high risk suicide precautions with fewer patients left undetected. Future work involves assigning all patients a risks score following C-SSRS screening.

Conclusion/Implications:

Combining PHQ-9 and C-SSRS appears to be helpful with stratifying suicide risk in medical inpatients.



References:

Na PJ, Yaramala SR, Kim JA, Kim H, Goes FS, Zandi PP, Vande Voort JL, Sutor B, Croarkin P, Bobo WV. The PHQ-9 Item 9 based screening for suicide risk: a validation study of the Patient Health Questionnaire (PHQ)-9 Item 9 with the Columbia Suicide Severity Rating Scale (C-SSRS). J Affect Disord. 2018 May;232:34-40. doi: 10.1016/j.jad.2018.02.045. Epub 2018 Feb 17. PMID: 29477096.

Rossom RC, Coleman KJ, Ahmedani BK, Beck A, Johnson E, Oliver M, Simon GE. Suicidal ideation reported on the PHQ9 and risk of suicidal behavior across age groups. J Affect Disord. 2017 Jun;215:77-84. doi: 10.1016/j.jad.2017.03.037. Epub 2017 Mar 16. PMID: 28319695; PMCID: PMC5412508.