title: Characteristics, management, and depression outcomes of primary care patients who endorse thoughts of death or suicide on the PHQ-9.
abstract: BACKGROUND
  With increasing emphasis on integrating behavioral health services, primary care providers play an important role in managing patients with suicidal thoughts.
  
  
  OBJECTIVE
  To evaluate whether Patient Health Questionnaire-9 (PHQ-9) Item 9 scores are associated with patient characteristics, management, and depression outcomes in a primary care-based mental health program.
  
  
  METHODS
  Observational analysis of data collected from a patient registry.
  
  
  METHODS
  Eleven thousand fifteen adults enrolled in the Mental Health Integration Program (MHIP).
  
  
  METHODS
  MHIP provides integrated mental health services for safety-net populations in over 100 community health centers across Washington State. Key elements of the team-based model include: a disease registry; integrated care management; and organized psychiatric case review.
  
  
  METHODS
  The independent variable, suicidal ideation (SI), was assessed by PHQ-9 Item 9. Depression severity was assessed with the PHQ-8. Outcomes included four indicators of depression treatment process (care manager contact, psychiatric case review, psychotropic medications, and specialty mental health referral), and two indicators of depression outcomes (50 % reduction in PHQ-9 score and PHQ-9 score < 10).
  
  
  RESULTS
  SI was common (45.2 %) at baseline, with significantly higher rates among men and patients with greater psychopathology. Few patients with SI (5.4 %) lacked substantial current depressive symptoms. After adjusting for age, gender, and severity of psychopathology, patients with SI received follow-up earlier (care manager contact HR = 1.05, p < 0.001; psychiatric review HR = 1.02, p < 0.05), and were more likely to receive psychotropic medications (OR = 1.11, p = 0.001) and specialty referral (OR = 1.23, p < 0.001), yet were less likely to achieve a PHQ-9 score < 10 (HR = 0.87, p < 0.001).
  
  
  CONCLUSIONS
  Suicidal thoughts are common among safety-net patients referred by primary care providers for behavioral health care. Scores on Item 9 of the PHQ-9 are easily obtainable in primary care, may help providers initiate conversations about suicidality, and serve as useful markers of psychiatric complexity and treatment-resistance. Patients with positive scores should receive timely and comprehensive psychiatric evaluation and follow-up.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195-6560, USA. abauer1@uw.edu
authors.forename: Amy M
authors.initials: AM
authors.lastname: Bauer
authors.forename: Ya-Fen
authors.initials: YF
authors.lastname: Chan
authors.forename: Hsiang
authors.initials: H
authors.lastname: Huang
authors.forename: Steven
authors.initials: S
authors.lastname: Vannoy
authors.forename: Jürgen
authors.initials: J
authors.lastname: Unützer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D011569:Psychiatric Status Rating Scales; D012042:Registries; D012737:Sex Factors; D059020:Suicidal Ideation; D016896:Treatment Outcome; D055815:Young Adult