Kristianne Chelsea Altura1, Scott B Patten2, Kirsten M Fiest3, Callie Atta1, Andrew G Bulloch2, Nathalie Jetté4. 1. Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 2T9, Canada. 2. Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 2T9, Canada; Department of Psychiatry and Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 2T9, Canada. 3. Department of Internal Medicine, University of Manitoba, Winnipeg, MB R3T 2N2, Canada. 4. Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 2T9, Canada. Electronic address: nathalie.jette@albertahealthservices.ca.
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.
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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