title: Implications of two-stage depression screening for identifying persons with thoughts of self-harm.
abstract: OBJECTIVE
  Persons with thoughts of self-harm may need evaluation for suicide risk. We examine the prevalence of thoughts of self-harm and whether persons with thoughts of self-harm are identified when two-stage depression screening is used.
  
  
  METHODS
  Data are from the 2005-2010 National Health and Nutrition Examination Surveys. Persons responding positively to question nine of the Patient Health Questionnaire-9 (PHQ-9) are identified as having thoughts of self-harm. We compare two depression cutoff scores for the Patient Health Questionnaire-2 (PHQ-2) to see what percentage of persons with thoughts of self-harm would be identified as needing further screening with the PHQ-9.
  
  
  RESULTS
  The prevalence of thoughts of self-harm was 3.5%. Persons 12-17 years old, poor and reporting fair or poor health were more likely to report thoughts of self-harm. A cutoff score of three on the PHQ-2 identified 49% of persons with thoughts of self-harm for further screening with the PHQ-9. A cut point of two increased the proportion of persons with thoughts of self-harm continuing for further screening to 76%.
  
  
  CONCLUSIONS
  Using a lower cutoff score, two, the PHQ-2 captures more persons with thoughts of self-harm. One quarter of persons with self-harm thoughts may not be identified for further screening when two-stage screening is used.
authors.affiliation: Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention. Electronic address: lpratt@cdc.gov.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Pratt
authors.affiliation: Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention.
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Brody
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009749:Nutrition Surveys; D018570:Risk Assessment; D016728:Self-Injurious Behavior / Q000175:diagnosis* / Q000523:psychology; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D055815:Young Adult; D000092864:Suicide Prevention
keywords: Depression; NHANES; PHQ-9; Screening; Self-harm