Limitations of Screening for Depression as a Proxy for Suicide Risk in Adult Medical Inpatients

Background: Medically ill hospitalized patients are at elevated risk for suicide. Hospitals that already screen for depression often use depression screening as a proxy for suicide risk screening. Extant research has indicated that screening for depression may not be sufficient to identify all patients at risk for suicide. Objective: The present study aims to determine the effectiveness of a depression screening tool, the Patient Health Questionnaire-9, in detecting suicide risk among adult medical inpatients. Methods: Participants were recruited from inpatient medical/surgical units in 4 hospitals as part of a larger validation study. Participants completed the Patient Health Questionnaire-9 and 2 suicide risk measures: the Ask Suicide-Screening Questions and the Adult Suicidal Ideation Questionnaire. Results: The sample consisted of 727 adult medical inpatients (53.4% men; 61.8% white; mean age 50.1 ± 16.3 years). A total of 116 participants (116 of 727 [16.0%]) screened positive for suicide risk and 175 (175 of 727 [24.1%]) screened positive for depression. Of the 116 patients who screened positive for suicide risk, 36 (31.0%) screened negative for depression on the Patient Health Questionnaire-9. Of 116, 73 (62.9%) individuals who were at risk for suicide did not endorse item 9 (thoughts of harming oneself or of being better off dead) on the Patient Health Questionnaire-9. Conclusion: Using depression screening tools as a proxy for suicide risk may be insufficient to detect adult medical inpatients at risk for suicide. Asking directly about suicide risk and using validated tools is necessary to effectively and efficiently screen for suicide risk in this population.