Utility of the Patient Health Questionnaire-9 to Assess Suicide Risk in Patients With Systemic Sclerosis
Article first published online: 23 APR 2013
Copyright © 2013 by the American College of Rheumatology
Arthritis Care & Research
Volume 65, Issue 5, pages 753–758, May 2013
How to Cite
Razykov, I., Hudson, M., Baron, M., Thombs, B. D. and Canadian Scleroderma Research Group (2013), Utility of the Patient Health Questionnaire-9 to Assess Suicide Risk in Patients With Systemic Sclerosis. Arthritis Care Res, 65: 753–758. doi: 10.1002/acr.21894
- Issue published online: 23 APR 2013
- Article first published online: 23 APR 2013
- Accepted manuscript online: 30 NOV 2012 03:53PM EST
- Manuscript Accepted: 23 OCT 2012
- Manuscript Received: 19 JUN 2012
- Health Professional Investigator Award from the Rheumatology Research Foundation of the American College of Rheumatology
- Fonds de la Recherche en Santé du Québec. Grant Number: dossier 14409
- Canadian Institutes of Health Research. Grant Numbers: 201108TR3-267681-TRF-CFAF-165164, FRN 83518
- Scleroderma Society of Canada and its provincial chapters
- Scleroderma Society of Ontario, Sclérodermie Québec
- Cure Scleroderma Foundation
- Inova Diagnostics (San Diego, California)
- Dr. Fooke Laboratorien (Neuss, Germany)
- Euroimmun (Lubeck, Germany)
- Mikrogen (Neuried, Germany)
- Fonds de la Recherche en Santé du Québec
- Canadian Arthritis Network
- Lady Davis Institute of Medical Research of the Jewish General Hospital, Montreal, Quebec, Canada
- McGill University Faculty of Medicine Alexander McFee Fellowship Award
- Canadian Scleroderma Research Group Studentship Award
- Canadian Institutes of Health Research Strategic Training Initiative in Health Research. Grant Number: SKI 83345
- New Investigator Awards from the Canadian Institutes of Health Research
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 in arthritis. The objectives of this study were 1) to determine the proportion of systemic sclerosis (SSc; scleroderma) patients who responded “yes” to item 9 who endorsed active suicidal ideation in response to more direct questions during a structured clinical interview, and 2) to report whether the PHQ-8, which does not include item 9 from the PHQ-9, performs similarly to the PHQ-9.
Patients were recruited from the Canadian Scleroderma Research Group Registry. The PHQ-9 and Composite International Diagnostic Interview (CIDI) depression module were administered during a phone interview. Scores on the PHQ-8 were calculated by removing item 9 from the PHQ-9. Item 9 responses were compared to suicidal ideation and intent in the last year based on the CIDI. Scores on the PHQ-8 and PHQ-9 were compared using Pearson's correlations.
There were 345 patients interviewed, of whom 31 (9.0%) endorsed item 9 of the PHQ-9. Of those, based on the CIDI, 14 (45.2%) had passive thoughts of suicide or death. Only 1 patient (3.2%) had thoughts about suicide in some detail at any point in the last 12 months. The correlation between PHQ-9 and PHQ-8 scores was 0.998.
Item 9 appears to identify many patients who do not report active suicidal ideation. The PHQ-8 may be a better option for assessment of depressive symptoms than the PHQ-9 in patients with SSc.