Method of assessment determines prevalence of suicidal ideation among patients with depression

• Published in: European psychiatry Vol. 29; no. 6; pp. 338 - 344
• Main Authors: Vuorilehto, M, Valtonen, H.M, Melartin, T, Sokero, P, Suominen, K, Isometsä, E.T
• Format: Journal Article
• Language: English
• Published: Paris Elsevier Masson SAS 01.08.2014; Elsevier
• Subjects: Adult; Adult and adolescent clinical studies; Biological and medical sciences; Cohort Studies; Depression; Depressive Disorder, Major - epidemiology; Depressive Disorder, Major - psychology; Female; General aspects; Humans; Internal Medicine; Major depressive disorder; Male; Medical sciences; Middle Aged; Miscellaneous; Mood disorders; Predictive Value of Tests; Prevalence; Primary health care; Psychiatric care; Psychiatric Status Rating Scales; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk Factors; Sensitivity and Specificity; Suicidal Ideation; Suicide; Suicide - psychology; Suicide - statistics & numerical data; Suicide attempts; Suicide attempts; Suicidal ideation; Suicide; Psychiatric care; Primary health care; Major depressive disorder; Mood disorder; Human; Evaluation; Prevalence; Depression; Epidemiology; Suicide attempt; Treatment; Mental disorder; Suicide ideation; Public health
• ISSN: 0924-9338; 1778-3585
• DOI: 10.1016/j.eurpsy.2013.08.005

Abstract Background How different ways of assessing suicidal ideation influence its prevalence, correlates and predictive validity among patients with major depressive disorder (MDD) remains unclear. Methods Within the Vantaa Primary Care Depression Study (PC-VDS, 91 patients) and the Vantaa Depression Study (VDS, 153 psychiatric out-and 41 inpatients), suicidal ideation was assessed with the Scale for Suicidal Ideation (SSI), Hamilton Depression Scale (HAM-D) item 3 and Beck Depression Inventory (BDI) item 9, and by asking whether patients had seriously considered suicide during the episode. The positive and negative predictive values (PPV, NPV) for suicide attempts during a six-month follow-up were investigated. Results Depending on the setting, 56–88% of patients had suicidal ideation in some of the assessments, but only 8–44% in all of them. Agreement ranged from negligible to moderate (kappa 0.06–0.64), being lowest among primary care patients. The correlates of suicidal ideation overlapped. No assessment had optimal sensitivity, specificity, PPV and NPV. Nevertheless, PPVs ranged up to 43%. Conclusions Which MDD patient is classified as having suicidal ideation depends strongly on the method of assessment, with the greatest variation likely in primary care. Differences in assessments may cause inconsistency in risk factors. Predicting suicide attempts is difficult, but not futile.