Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN.
Department of Clinical Health Psychology, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, CAN.
Inflamm Bowel Dis. 2018 Jul 12;24(8):1641-1648. doi: 10.1093/ibd/izy032.
Suicide is a leading cause of death worldwide. Transition from suicidal ideation (SI) to suicide attempt is high within a year of SI onset. The risk of suicide and SI is elevated in persons with inflammatory bowel disease (IBD) versus the general population. We aimed to validate the Patient Heath Questionnaire (PHQ)-9 as a screening tool for SI in IBD and to determine factors associated with SI in IBD.
IBD participants (n = 247) recruited from the community and clinics completed the PHQ-9 and participated in the Structured Clinical Interview for DSM-IV (SCID). We determined the sensitivity, specificity, and positive and negative predictive value (PPV and NPV) of the PHQ-9 in identifying SI as compared to the SCID. Using logistic regression we examined the association of SI with demographic and clinical factors.
SI was endorsed by 24 (9.7%) participants on the PHQ-9 and 5 (2.0%) based on the SCID. The PHQ-9 had good sensitivity (100%), specificity (92.2%), and NPV (100%) but low PPV (20.8%) for SI. On univariate analysis, factors strongly associated with SI were depression (OR 13.1; 95%CI: 4.46, 40.5), anxiety (OR 11.3; 95%CI: 4.46, 28.6), and active disease (OR 3.87; 95%CI: 1.54, 9.71). On multivariable analysis, depression (OR 5.54; 95%CI: 1.67, 18.4) and pain (OR 1.14; 95%CI: 1.03, 1.25) were associated with SI.
Overall the PHQ-9 is a valid screening tool for SI in IBD patients, and routine implementation of this tool would support screening for depression and SI effectively and efficiently in clinical practice.
自杀是全球范围内的主要死亡原因之一。在出现自杀意念（SI）后的一年内，从有自杀意念过渡到自杀企图的风险很高。与普通人群相比，患有炎症性肠病（IBD）的人自杀和出现自杀意念的风险更高。我们旨在验证患者健康问卷（PHQ-9）作为 IBD 患者自杀意念的筛查工具，并确定与 IBD 患者自杀意念相关的因素。
我们从社区和诊所招募了 247 名 IBD 参与者，他们完成了 PHQ-9 并参加了 DSM-IV 结构化临床访谈（SCID）。我们确定了 PHQ-9 在识别 SI 方面与 SCID 相比的灵敏度、特异性、阳性和阴性预测值（PPV 和 NPV）。使用逻辑回归，我们检查了 SI 与人口统计学和临床因素的关联。
24 名（9.7%）参与者在 PHQ-9 上表示有自杀意念，5 名（2.0%）参与者根据 SCID 表示有自杀意念。PHQ-9 对 SI 的灵敏度（100%）、特异性（92.2%）和 NPV（100%）较高，但 PPV（20.8%）较低。在单变量分析中，与 SI 强烈相关的因素是抑郁（OR 13.1；95%CI：4.46，40.5）、焦虑（OR 11.3；95%CI：4.46，28.6）和活动期疾病（OR 3.87；95%CI：1.54，9.71）。在多变量分析中，抑郁（OR 5.54；95%CI：1.67，18.4）和疼痛（OR 1.14；95%CI：1.03，1.25）与 SI 相关。
总体而言，PHQ-9 是 IBD 患者自杀意念的有效筛查工具，在临床实践中常规实施该工具将有效且高效地支持对抑郁和 SI 的筛查。
