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

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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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Self-citation
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“…currently having suicidal thoughts and behaviors if they gave a rating of 1 or higher (i.e., at least some of the time) on any of these three items, or on item 9 of the PHQ-9 (“having thoughts that you would be better off dead or thoughts of physically harming yourself” in the last two weeks) [18].”
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“Moreover, the ninth item has false negative rates ranging from 11–72% (Louzon et al., 2016; Simon et al., 2013; Uebelacker et al., 2011).”
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InfluentialSelf-citation
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“However, many Veteran suicides occur in patients who respond “not at all” to item 9 (20).”
Background
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“Additionally, a previous study utilizing the PHQ-9 indicated that 71.6% of suicides were among patients who responded “not at all” when asked if they had “thoughts that you would be better off dead, or thoughts of hurting yourself in some way” (16).”
MethodInfluential
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“…both as a continuous value and in a binary fashion (0 = not at all; 1 = any frequency of suicidal ideation) and has shown its validity, for example, it outperformed the suicidal ideation item included in the Columbia Suicide Severity Rating Scale, 40 and it predicted suicide deaths 41 and attempts.”
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“A 2016 study (Louzon et al., 2016) found that patients in the Veterans Health Administration system were at an increased risk of suicide when they exhibited higher levels of suicidal ideation, as indicated by Item 9 of the PHQ-9.”
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Background
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Cyr, K. S., Nazarov, A., Le, T., Nouri, M. S., Saha, P., Forchuk, C. A., Soares, V., Wanklyn, S. G., Bird, B. M., Davis, B. D., et al. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05237-2 · Cited by 2
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Method
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“In one study, 71.6% of suicide deaths among VA patients during the surveillance period were among those who did not report suicidal ideation on the Patient Health Questionnaire-9 at their most recent evaluation (Louzon et al., 2016).”
Influential
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“Consistent with research in Veteran populations (Louzon et al., 2016), the presence and frequency of suicidal ideation was assessed using item nine of the PHQ-9: “ Over the last 2 weeks, how often have you been bothered by thoughts that you would be better o ﬀ dead, or of hurting yourself?”
Method
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Additional file 1 of Change in suicidal ideation, depression, and anxiety following collaborative care in the community
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“Although item 9 on the PHQ-9 has been shown to be a clinically meaningful, predictive marker of subsequent suicide attempts and suicide death [8-10], it does not distinguish between passive death ideation (“thoughts you would be better off dead”) and active self-injurious ideation (“hurting…”
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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
Health Sciences › Medicine › Psychiatry and Mental health › 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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