The PHQ-9 versus the PHQ-8 — Is item 9 useful for assessing suicide risk in coronary artery disease patients? Data from the Heart and Soul Study
Open accessAbstract
Objective Item 9 of the Patient Health Questionnaire-9 (PHQ-9), which inquires about both passive thoughts of death and active ideas of self-harm, has been used to assess suicide risk. The objectives of this study were (1) to determine the proportion of patients who responded "yes" to Item 9 who endorsed active suicidal ideation in response to more direct questions from a structured clinical interview and (2) to compare the sensitivity and specificity for detecting cases of depression of the PHQ-9 and the PHQ-8, which does not include Item 9, as well as the correlation between the PHQ-8 and PHQ-9.Methods Coronary artery disease (CAD) outpatients were administered the PHQ-9 and the Computerized Diagnostic Interview Schedule (C-DIS). Item 9 responses were compared to suicidal ideation and intent in the last year based on the C-DIS. Scores on the PHQ-8 were obtained by eliminating Item 9 from the PHQ-9. Test characteristics of the PHQ-9 and PHQ-8 were compared.Results Of 1022 patients, 110 (10.8%) endorsed Item 9. Of those, only 22 (19.8%) reported thoughts about committing suicide, and only 9 of those (8.1%) reported a suicide plan any time in the last year based on the C-DIS. Correlation between PHQ-9 and PHQ-8 scores was r=0.997. Sensitivity and specificity for the PHQ-9 (54%, 90%) and PHQ-8 (50%, 91%) to detect major depression were similar.Conclusion Item 9 does not appear to be an accurate suicide screen. The PHQ-8 may be a better option than the PHQ-9 in CAD patients.
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The PHQ-9 has strong psychometric properties among older adults, and the PHQ-8 and PHQ-9 are highly correlated.
“Psychometric properties of the PHQ-9 are strong among older adults, and the two versions of the scale are highly correlated (Razykov, Ziegelstein, Whooley, & Thombs, 2012).”
From Cognitive-behavioral therapy for late-life anxiety: Similarities and differences between Veteran and community participants (2015) · cites this paper as Razykov, Ziegelstein, Whooley, & Thombs, 2012
The PHQ-9 Versus the PHQ-8 results (page not provided) report a very high correlation between the scales (r = 0.997). The paper assesses outpatients with coronary artery disease, not older adults as a group, and does not establish that the PHQ-9 has strong psychometric properties among older adults. (LLM, conf=0.88)
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- Authors
- Razykov, I., Ziegelstein, R. C., Whooley, M. A., & Thombs, B. D.
- Affiliations
- Jewish General Hospital (CA)
- Johns Hopkins University (US)
- San Francisco VA Medical Center (US)
- Corresponding author
- Thombs, Brett D.
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2012-09
- Volume
- 73
- Issue
- 3
- Pages
- 163-168
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W2015188398
- Cited by
- 188
- References
- 52
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 11 · 2023: 26 · 2022: 21 · 2021: 16 · 2020: 12 · 2019: 23 · 2018: 12 · 2017: 10 · 2016: 8 · 2015: 7 · 2014: 12 · 2013: 7 · 2012: 2
- FWCI
- 10.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- eScholarship@McGill (McGill) (submittedVersion, cc-by-nc-nd)
- Funders
- National Center for Complementary and Alternative Medicine (R24AT004641)
- Miller Family Scholar Program of the Johns Hopkins Center for Innovative Medicine
- New Investigator Award from the Canadian Institutes of Health Research
- Établissement de Jeunes Chercheurs award from the Fonds de la Recherche en Santé Québec
- Department of Veterans Affairs, Washington, DC
- National Heart Lung and Blood Institute (R01 HL079235)
- American Federation for Aging Research (Paul Beeson Scholars Program), New York, NY
- Robert Wood Johnson Foundation (Faculty Scholars Program), Princeton, NJ
- Ischemia Research and Education Foundation, South San Francisco, CA
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
- Keywords
- PHQ-9, PHQ-8, suicide risk screening, suicidal ideation, coronary artery disease, depression screening, suicide planning, self-harm, sensitivity and specificity, Heart and Soul Study
- MeSH terms
- Suicide Prevention, Aged, Aged, 80 and over, Coronary Disease, Major Depressive Disorder, Depressive Disorder, Major, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Surveys and Questionnaires, Sensitivity and Specificity, Suicide, Risk Assessment, Suicidal Ideation
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