title: Prevalence and correlates of suicide ideation in patients with COPD: a mixed methods study.
abstract: OBJECTIVE
  The purpose of this study was to examine the prevalence and correlates of suicidal ideation (SI) in patients with stable moderate to very severe chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  We conducted an exploratory mixed methods analysis of data from participants in a longitudinal observational study of depression in COPD. We measured depression with the Patient Health Questionnaire-9 (PHQ-9), which includes an item on SI. We compared participants with and without SI in relation to sociodemographics, symptoms, anxiety, and healthcare resource use with independent t-tests and chi-square tests. Content analysis was performed on qualitative data gathered during a structured SI safety assessment.
  
  
  RESULTS
  Of 202 participants, 121 (60%) had depressive symptoms (PHQ ≥6); 51 (25%) had a PHQ-9 ≥10, indicating a high likelihood of current major depression; and 22 (11%) reported SI. Compared to the 99 depressed participants without SI, those with SI were more likely to be female (59% vs 27%, P=0.004); had worse dyspnea (P=0.009), depression (P<0.001), and anxiety (P=0.003); and were also more likely to have received treatment for depression and/or anxiety (82% vs 40%, P<0.001) and more hospitalizations for COPD exacerbations (P=0.03) but had similar levels of airflow obstruction and functioning than participants without SI. Themes from the qualitative analysis among those with SI included current or prior adverse life situations, untreated or partially treated complex depression, loss of a key relationship, experience of illness and disability, and poor communication with providers.
  
  
  CONCLUSIONS
  Our findings suggest that current SI is common in COPD, may occur disproportionately in women, can persist despite mental health treatment, and has complex relationships with both health and life events. Adequate management of SI in COPD may therefore require tailored, comprehensive treatment approaches that integrate medical and mental health objectives.
authors.affiliation: School of Nursing, University of Washington, Seattle, WA, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Fleehart
authors.affiliation: VAPuget Sound Health Care Center, Seattle, WA, USA ; School of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Vincent S
authors.initials: VS
authors.lastname: Fan
authors.affiliation: Reseach and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
authors.forename: Huong Q
authors.initials: HQ
authors.lastname: Nguyen
authors.affiliation: School of Nursing, University of Washington, Seattle, WA, USA.
authors.forename: Jungeun
authors.initials: J
authors.lastname: Lee
authors.affiliation: School of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Kohen
authors.affiliation: Department of Sociology, University of Washington, Seattle, WA, USA.
authors.forename: Jerald R
authors.initials: JR
authors.lastname: Herting
authors.affiliation: VAPuget Sound Health Care Center, Seattle, WA, USA ; School of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Matute-Bello
authors.affiliation: School of Medicine, University of Texas Health Science Center ; South Texas Veterans Health Care System, San Antonio, TX, USA.
authors.forename: Sandra G
authors.initials: SG
authors.lastname: Adams
authors.affiliation: School of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Pagalilauan
authors.affiliation: School of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Soo
authors.initials: S
authors.lastname: Borson
mesh_terms: D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D016009:Chi-Square Distribution; D015897:Comorbidity; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D004185:Disability Evaluation; D005260:Female; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
keywords: PHQ-9; chronic obstructive; depression; pulmonary disease; qualitative; suicide