Does Suicidal Ideation as Measured by the PHQ-9 Predict Suicide Among VA Patients?

Louzon, Samantha A.; Bossarte, Robert; McCarthy, John F.; Katz, Ira R.

doi:10.1176/appi.ps.201500149

Cited by 291Suicide and Self-Harm StudiesOpioid Use Disorder TreatmentMental Health Treatment and Access

Does Suicidal Ideation as Measured by the PHQ-9 Predict Suicide Among VA Patients?

Louzon, Samantha A., Bossarte, Robert, McCarthy, John F., Katz, Ira R.·2016·Psychiatric Services

DOI 10.1176/appi.ps.201500149

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Abstract

OBJECTIVE: Frequency of suicidal ideation in the past two weeks, assessed by item 9 of the nine-item Patient Health Questionnaire (PHQ-9), has been positively associated with suicide mortality among patients in a setting other than the Veterans Health Administration (VHA). To inform suicide prevention activities at the VHA, it is important to evaluate whether item 9 is associated with suicide risk among patients in the VHA system. METHODS: PHQ-9 assessments (N=447,245) conducted by the VHA between October 1, 2009, and September 30, 2010, were collected. National Death Index data were used to ascertain suicide mortality from the date of PHQ-9 assessment through September 30, 2011. Multivariable proportional hazards regressions were used to evaluate associations between responses to item 9 and suicide mortality. RESULTS: After the analyses adjusted for covariates, a response of "several days" for item 9 was associated with a 75% increased risk of suicide (hazard ratio [HR]=1.75, 95% confidence interval [CI]=1.24-2.46), a response of "more than half the days" was associated with a 115% increased risk of suicide (HR=2.15, CI=1.32-3.51), and a response of "nearly every day" was associated with a 185% increased risk of suicide (HR=2.85, CI=1.81-4.47), compared with a response of "not at all." However, 71.6% of suicides during the study period occurred among patients who responded "not at all" to item 9 from their most recent PHQ-9. CONCLUSIONS: Higher levels of suicidal ideation, indicated by item 9 of the PHQ-9, were associated with increased risk of suicide among patients in the VHA system.

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The presence or absence of suicidal ideation was determined using PHQ-9 Item 9, and evidence endorses its use as a general screening tool for identifying suicidal ideators.
“The presence or absence of suicidal ideation was determined using Item 9 of the Patient Health Questionnaire-9 (PHQ-9).1314 Evidence endorsing its use as a general screening tool for identifying suicidal ideators continues to accumulate.13”
From Prevalence and Correlates of Suicidal Ideation among Psycho-Oncology Outpatients (2024) · cites this paper as [13]
The PHQ-9 is a valid and reliable measure of depressed mood.
“The PHQ‐9 is valid and reliable measure of depressed mood and is often used in case identification (Louzon et al., 2016).”
From Effectiveness of cognitive analytic therapy for bipolar affective disorder: A co‐produced single subject cumulative treatment design with extended follow‐up (A <sup>1</sup> /B/A <sup>2</sup> /C‐FU) (2022) · cites this paper as Louzon et al., 2016

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Authors: Louzon, S. A., Bossarte, R., McCarthy, J. F., & Katz, I. R.
Affiliations: United States Department of Veterans Affairs (US)
ORCID: Bossarte, Robert
Katz, Ira R.
Venue: Psychiatric Services
Publisher: American Psychiatric Association Publishing
Published: 2016-05-01
Volume: 67
Issue: 5
Pages: 517-522
ISSN: 0022-1597 (ISSN-L)
1075-2730
1557-9700
DOI: 10.1176/appi.ps.201500149
OpenAlex: W2239385095
Cited by: 291
References: 18
Citations by year: 2026: 16 · 2025: 33 · 2024: 24 · 2023: 44 · 2022: 32 · 2021: 44 · 2020: 33 · 2019: 28 · 2018: 23 · 2017: 9 · 2016: 5
FWCI: 29.05
Type: journal article
Language: en
Open access: closed
Locations: Psychiatric Services (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords: suicidal ideation, PHQ-9, suicide mortality, suicide risk, veterans, suicide prevention, Patient Health Questionnaire, suicide risk screening, Veterans Health Administration
MeSH terms: Patient Health Questionnaire, Suicide Prevention, Adult, Aged, Aged, 80 and over, Mental Disorders, Female, Hospitals, Veterans, Humans, Male, Mass Screening, Middle Aged, Risk Factors, Suicide, United States, Veterans, Multivariate Analysis, Proportional Hazards Models, Suicidal Ideation

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Does Suicidal Ideation as Measured by the PHQ-9 Predict Suicide Among VA Patients?

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