title: Thoughts of death and suicide reported by cancer patients who endorsed the "suicidal thoughts" item of the PHQ-9 during routine screening for depression.
abstract: BACKGROUND
  Patients with serious medical illnesses, such as cancer, are at increased risk of suicide but are also often facing death. The Patient Health Questionnaire-9 (PHQ-9) is widely used to screen patients for depression. It includes an item that asks about thoughts of death and hurting yourself (Item-9).
  
  
  OBJECTIVE
  To describe the nature of thoughts of death and suicide reported in clinical interviews carried out to further assess suicidal ideation of cancer outpatients who had endorsed the "suicidal thoughts item" (Item-9) of the PHQ-9 during routine depression screening.
  
  
  METHODS
  Secondary analysis of anonymized service data (with ethical approval) derived from the routine clinical administration of self-report questionnaires and telephone interviews to outpatients attending a Cancer Centre in the UK.
  
  
  RESULTS
  Complete data were available on 330/463 (71%) of patients who had endorsed Item-9. In a subsequent structured telephone interview, approximately one-third of these patients denied any thoughts that they would be better off dead, another third acknowledged having thoughts that they would be better off dead, but not of suicide, and the remaining third reported clear thoughts of committing suicide.
  
  
  CONCLUSIONS
  Only one-third of cancer outpatients who endorse the "suicidal thoughts item" of the PHQ-9 report suicidal thoughts at a subsequent interview. Services planning to set up depression screening with the PHQ-9 need to carefully consider the relative benefits and burden to their service and patients of including Item-9 and interviewing all those who endorse it.
authors: Psychological Medicine Research, Edinburgh Cancer Research Centre, School of Molecular and Clinical Medicine, University of Edinburgh, Scotland, UK. jane.walker@ed.ac.uk
authors: Jane
authors: J
authors: Walker
authors: Christian Holm
authors: CH
authors: Hansen
authors: Isabella
authors: I
authors: Butcher
authors: Neelom
authors: N
authors: Sharma
authors: Lucy
authors: L
authors: Wall
authors: Gordon
authors: G
authors: Murray
authors: Michael
authors: M
authors: Sharpe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D055815:Young Adult