Tsui Laboratory, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia.
JAMA Netw Open. 2024 Oct 1;7(10):e2438144. doi: 10.1001/jamanetworkopen.2024.38144.
Suicide is a leading cause of death in US youths.
To assess whether screening with supplemental items 10 to 13 on the Patient Health Questionnaire-9 modified for teens (PHQ-9M) improves prediction of youth suicide attempts beyond the information provided by the first 9 items alone (the PHQ-9).
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used a retrospective cohort of adolescents aged 12 to 17 years who were screened for depression in outpatient facilities within a pediatric health care system between January 1, 2016, and December 31, 2022, with up to 1 year of follow-up to assess the occurrence of suicidal behavior. Follow-up was completed on December 31, 2023.
Screening with the PHQ-9M.
This study developed and compared prediction using 3 Cox proportional hazards regression models (CR-9, CR-13, and CR-3) of subsequent suicide attempts, determined by the hospital's electronic health records up to 1 year following the last PHQ-9M screening. The CR-9 model used the PHQ-9 and the CR-13 model used all 13 items of PHQ-9M. The CR-3 model used the 3 most impactful variables selected from the 13 PHQ-9M items and PHQ-9 total score. All models were evaluated across 4 prediction horizons (30, 90, 180, and 365 days) following PHQ-9M screenings. Evaluation metrics were the area under the receiver operating characteristic curve (AUROC) and the area under the precision recall curve (AUPRC).
Of 130 028 outpatients (65 520 [50.4%] male) with 272 402 PHQ-9M screenings, 549 (0.4%) had subsequent suicide attempts within 1 year following the PHQ-9M screening. The AUROC of the CR-9 model in the 365-day horizon was 0.77 (95% CI, 0.75-0.79); of the CR-13 model, 0.80 (95% CI, 0.78-0.82); and of the CR-3 model, 0.79 (95% CI, 0.76-0.81); the AUPRC of the CR-9 model was 0.02 (95% CI, 0.02-0.03); of the CR-13 model, 0.03 (95% CI, 0.02-0.03); and of the CR-3 model, 0.02 (95% CI, 0.02-0.03). The 3 most impactful items using adjusted hazard ratios were supplemental item 13 (lifetime suicide attempts; 3.06 [95% CI, 2.47-3.80]), supplemental item 10 (depressed mood severity in the past year; 2.99 [95% CI, 2.32-3.86]), and supplemental item 12 (serious suicidal ideation in the past month; 1.63 [95% CI, 1.25-2.12]). All of the models achieved higher AUROCs as prediction horizons shortened.
In this cohort study of adolescent PHQ-9M screenings, the supplemental items on PHQ-9M screening improved prediction of youth suicide attempts compared with screening using the PHQ-9 across all prediction horizons, suggesting that PHQ-9M screening should be considered during outpatient visits to improve prediction of suicide attempts.
自杀是美国青少年死亡的主要原因。
评估青少年患者健康问卷-9 修订版（PHQ-9M）的补充项目 10 至 13 是否可以改善对青少年自杀企图的预测，超过仅使用前 9 个项目提供的信息（PHQ-9）。
设计、地点和参与者：这是一项回顾性队列研究，使用了一个回顾性队列，其中包括在儿科医疗保健系统的门诊设施中接受抑郁症筛查的 12 至 17 岁青少年，随访时间长达 1 年，以评估自杀行为的发生。随访于 2023 年 12 月 31 日完成。
PHQ-9M 筛查。
本研究开发并比较了 3 个 Cox 比例风险回归模型（CR-9、CR-13 和 CR-3）对随后自杀企图的预测，这些预测是根据医院的电子健康记录确定的，随访时间为最后一次 PHQ-9M 筛查后 1 年。CR-9 模型使用 PHQ-9，CR-13 模型使用 PHQ-9M 的所有 13 个项目。CR-3 模型使用从 PHQ-9M 项目和 PHQ-9 总分中选择的 3 个最具影响力的变量。所有模型都在 PHQ-9M 筛查后的 4 个预测时间范围内（30、90、180 和 365 天）进行了评估。评估指标是接受者操作特征曲线下的面积（AUROC）和精度召回曲线下的面积（AUPRC）。
在 130028 名门诊患者（65520 名男性[50.4%]）中进行了 272402 次 PHQ-9M 筛查，其中 549 名（0.4%）在 PHQ-9M 筛查后 1 年内发生了自杀企图。CR-9 模型在 365 天预测时间的 AUROC 为 0.77（95%CI，0.75-0.79）；CR-13 模型为 0.80（95%CI，0.78-0.82）；CR-3 模型为 0.79（95%CI，0.76-0.81）；CR-9 模型的 AUPRC 为 0.02（95%CI，0.02-0.03）；CR-13 模型为 0.03（95%CI，0.02-0.03）；CR-3 模型为 0.02（95%CI，0.02-0.03）。使用调整后的危险比，最具影响力的 3 个项目是补充项目 13（终生自杀企图；3.06[95%CI，2.47-3.80]）、补充项目 10（过去一年的抑郁情绪严重程度；2.99[95%CI，2.32-3.86]）和补充项目 12（过去一个月的严重自杀意念；1.63[95%CI，1.25-2.12]）。所有模型的 AUROC 随着预测时间的缩短而提高。
在这项青少年 PHQ-9M 筛查的队列研究中，与仅使用 PHQ-9 进行筛查相比，PHQ-9M 筛查的补充项目改善了对青少年自杀企图的预测，这表明在门诊就诊时应考虑进行 PHQ-9M 筛查，以提高自杀企图的预测能力。
