Adolescents Who Do Not Report Risk on the PHQ-9

A new study looked at characteristics of adolescents with depression who did not report suicide risk on item 9 of the Patient Health Questionnaire (PHQ-9) depression screener before self-harm or suicide. It found that those screened in primary care or those with prior inpatient mental health encounters were less likely to report suicide risk on the PHQ-9.

The study used electronic health records and claims data from primary care and mental health clinics across seven integrated U.S. health care systems from January 2009 through September 2017. The sample included 691 adolescents who completed the PHQ-9 within 30 days before self-harm or suicide and 1024 adolescents who completed it within 90 days. The mean age for both groups was 15.3.

The study found that 29% of the 30-day cohort and 32% of the 90-day cohort did not report thoughts of self-harm or suicide on the PHQ-9. Adolescents with a history of inpatient hospitalization and mental health diagnosis were least likely to report within 30 days, and those seen in primary care and older adolescents were least likely to report within 90 days.

The authors suggested that more research is needed to understand why adolescents appear to be reluctant to share thoughts of self-harm or suicide on the PHQ-9, a widely-used instrument to identify suicide risk.

Flores, J. P., Kahn, G., Penfold R. B., Stuart, E. A., Ahmedani, B. K., Beck, A., Boggs, J. M., Coleman, K. J., Daida, Y. G., Lynch, F. L., Richards, J. E., Rossom, R. C., Simon, G. E., & Wilcox, H. C. (2024). Adolescents who do not endorse risk via the Patient Health Questionnaire before self-harm or suicide. JAMA Psychiatry, 81(7), 717–726. doi:10.1001/jamapsychiatry.2024.0603