title: Disagreement between self-reported and clinician-ascertained suicidal ideation and its correlation with depression and anxiety severity in patients with major depressive disorder or bipolar disorder.
abstract: OBJECTIVE
  To study the disagreement between self-reported suicidal ideation (SR-SI) and clinician-ascertained suicidal ideation (CA-SI) and its correlation with depression and anxiety severity in patients with major depressive disorder (MDD) or bipolar disorder (BPD).
  
  
  METHODS
  Routine clinical outpatients were diagnosed with the MINI-STEP-BD version. SR-SI was extracted from the 16 Item Quick Inventory of Depression Symptomatology Self-Report (QIDS-SR-16) item 12. CA-SI was extracted from a modified Suicide Assessment module of the MINI. Depression and anxiety severity were measured with the QIDS-SR-16 and Zung Self-Rating Anxiety Scale. Chi-square, Fisher exact, and bivariate linear logistic regression were used for analyses.
  
  
  RESULTS
  Of 103 patients with MDD, 5.8% endorsed any CA-SI and 22.4% endorsed any SR-SI. Of the 147 patients with BPD, 18.4% endorsed any CA-SI and 35.9% endorsed any SR-SI. The agreement between any SR-SI and any CA-SI was 83.5% for MDD and 83.1% for BPD, with weighted Kappa of 0.30 and 0.43, respectively. QIDS-SR-16 score, female gender, and ≥4 year college education were associated with increased risk for disagreement, 15.44 ± 4.52 versus 18.39 ± 3.49 points (p = 0.0026), 67% versus 46% (p = 0.0783), and 61% versus 29% (p = 0.0096). The disagreement was positively correlated to depression severity in both MDD and BPD with a correlation coefficient R(2) = 0.40 and 0.79, respectively, but was only positively correlated to anxiety severity in BPD with a R(2) = 0.46.
  
  
  CONCLUSIONS
  Self-reported questionnaire was more likely to reveal higher frequency and severity of SI than clinician-ascertained, suggesting that a combination of self-reported and clinical-ascertained suicidal risk assessment with measuring depression and anxiety severity may be necessary for suicide prevention.
authors.affiliation: Mood and Anxiety Clinic in the Mood Disorders Program of the Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, USA. Electronic address: keming.gao@uhhospitals.org.
authors.forename: Keming
authors.initials: K
authors.lastname: Gao
authors.affiliation: Mood and Anxiety Clinic in the Mood Disorders Program of the Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, USA.
authors.forename: Renrong
authors.initials: R
authors.lastname: Wu
authors.affiliation: Mood and Anxiety Clinic in the Mood Disorders Program of the Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, USA.
authors.forename: Zuowei
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Mood and Anxiety Clinic in the Mood Disorders Program of the Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, USA.
authors.forename: Ming
authors.initials: M
authors.lastname: Ren
authors.affiliation: Mood and Anxiety Clinic in the Mood Disorders Program of the Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Kemp
authors.affiliation: Mood and Anxiety Clinic in the Mood Disorders Program of the Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, USA.
authors.forename: Philip K
authors.initials: PK
authors.lastname: Chan
authors.affiliation: Mood and Anxiety Clinic in the Mood Disorders Program of the Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, USA.
authors.forename: Carla M
authors.initials: CM
authors.lastname: Conroy
authors.affiliation: Mood and Anxiety Clinic in the Mood Disorders Program of the Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, USA.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Serrano
authors.affiliation: Mood and Anxiety Clinic in the Mood Disorders Program of the Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Ganocy
authors.affiliation: Mood and Anxiety Clinic in the Mood Disorders Program of the Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, USA.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Calabrese
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010552:Personality Assessment / Q000592:standards*; D011569:Psychiatric Status Rating Scales / Q000592:standards; D011594:Psychometrics / Q000592:standards; D057566:Self Report / Q000592:standards*; D012720:Severity of Illness Index; D059020:Suicidal Ideation; D055815:Young Adult
keywords: Anxiety severity; Clinician-ascertained suicidal ideation; Depressive severity; Disagreement; Mood disorder; Self-reported suicidal ideation