Implications of two-stage depression screening for identifying persons with thoughts of self-harm

• Published in: General hospital psychiatry Vol. 36; no. 1; pp. 119 - 123
• Main Authors: Pratt, Laura A., Ph.D, Brody, Debra J., M.P.H
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.01.2014; Elsevier
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Biological and medical sciences; Child; Depression; Depressive Disorder - diagnosis; Depressive Disorder - psychology; Female; Humans; Male; Mass Screening - methods; Medical sciences; Middle Aged; Miscellaneous; Mood disorders; NHANES; Nutrition Surveys; PHQ-9; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk Assessment; Screening; Self-harm; Self-Injurious Behavior - diagnosis; Self-Injurious Behavior - psychology; Suicidal Ideation; Suicide Prevention; Surveys and Questionnaires; Young Adult; Screening; Depression; NHANES; PHQ-9; Self-harm; Mood disorder; Self injury; Self destruction; Medical screening; Thought
• ISSN: 0163-8343; 1873-7714
• DOI: 10.1016/j.genhosppsych.2013.09.007

Abstract Objective Persons with thoughts of self-harm may need evaluation for suicide risk. We examine the prevalence of thoughts of self-harm and whether persons with thoughts of self-harm are identified when two-stage depression screening is used. Methods Data are from the 2005–2010 National Health and Nutrition Examination Surveys. Persons responding positively to question nine of the Patient Health Questionnaire-9 (PHQ-9) are identified as having thoughts of self-harm. We compare two depression cutoff scores for the Patient Health Questionnaire-2 (PHQ-2) to see what percentage of persons with thoughts of self-harm would be identified as needing further screening with the PHQ-9. Results The prevalence of thoughts of self-harm was 3.5%. Persons 12–17 years old, poor and reporting fair or poor health were more likely to report thoughts of self-harm. A cutoff score of three on the PHQ-2 identified 49% of persons with thoughts of self-harm for further screening with the PHQ-9. A cut point of two increased the proportion of persons with thoughts of self-harm continuing for further screening to 76%. Conclusions Using a lower cutoff score, two, the PHQ-2 captures more persons with thoughts of self-harm. One quarter of persons with self-harm thoughts may not be identified for further screening when two-stage screening is used.