title: Use of the Patient Health Questionnaire-9 and a detailed suicide evaluation in determining imminent suicidality in distressed patients with cardiac disease.
abstract: BACKGROUND
  The risk of suicide is elevated in patients with cardiac disease in comparison with the general population.
  
  
  OBJECTIVE
  In distressed cardiac inpatients, we explored the use of Item 9 of the Patient Health Questionnaire-9, which inquires about thoughts of death or suicide, and a detailed suicide evaluation (DSE) triggered by positive responses to Item 9 as means of assessing suicide.
  
  
  METHODS
  Among cardiac inpatients endorsing current emotional distress, we recorded the prevalence of positive responses to Item 9, gathered information about outcomes and time spent completing the DSE, and examined the frequency of imminent suicidality identified by the DSE among Item 9-positive patients.
  
  
  RESULTS
  Among 366 patients, 77 (21%) answered affirmatively to Item 9. All DSEs were successfully completed but consumed 17 clinician hours. Among the 71 patients receiving the DSE, 2 (0.5% of total sample; 2.8% of Item 9-positive patients) were imminently suicidal (i.e., had intent or plan).
  
  
  CONCLUSIONS
  Nearly 1 in 4 patients had a positive response to Item 9, but very few had imminent suicidality; the DSE was easy to use and acceptable to patients but time consuming. A more narrowly focused alternative to Item 9 may more accurately predict imminent suicidality and reduce the burden of further detailed suicide screening.
authors: Harvard Medical School, Boston, MA (LS, SRB, SVM, CAM, JLJ, CMC, TEC, JCH); Department of Psychiatry, Massachusetts General Hospital, Boston, MA (LS, SRB, SVM, CAM, CMC, TEC, JCH).
authors: Laura
authors: L
authors: Suarez
authors: Harvard Medical School, Boston, MA (LS, SRB, SVM, CAM, JLJ, CMC, TEC, JCH); Department of Psychiatry, Massachusetts General Hospital, Boston, MA (LS, SRB, SVM, CAM, CMC, TEC, JCH). Electronic address: sbeach1@partners.org.
authors: Scott R
authors: SR
authors: Beach
authors: Harvard Medical School, Boston, MA (LS, SRB, SVM, CAM, JLJ, CMC, TEC, JCH); Department of Psychiatry, Massachusetts General Hospital, Boston, MA (LS, SRB, SVM, CAM, CMC, TEC, JCH).
authors: Shannon V
authors: SV
authors: Moore
authors: Harvard Medical School, Boston, MA (LS, SRB, SVM, CAM, JLJ, CMC, TEC, JCH); Department of Psychiatry, Massachusetts General Hospital, Boston, MA (LS, SRB, SVM, CAM, CMC, TEC, JCH).
authors: Carol A
authors: CA
authors: Mastromauro
authors: Harvard Medical School, Boston, MA (LS, SRB, SVM, CAM, JLJ, CMC, TEC, JCH); Division of Cardiology, Massachusetts General Hospital, Boston, MA (JLJ).
authors: James L
authors: JL
authors: Januzzi
authors: Harvard Medical School, Boston, MA (LS, SRB, SVM, CAM, JLJ, CMC, TEC, JCH); Department of Psychiatry, Massachusetts General Hospital, Boston, MA (LS, SRB, SVM, CAM, CMC, TEC, JCH).
authors: Christopher M
authors: CM
authors: Celano
authors: Harvard Medical School, Boston, MA (LS, SRB, SVM, CAM, JLJ, CMC, TEC, JCH); Department of Psychiatry, Massachusetts General Hospital, Boston, MA (LS, SRB, SVM, CAM, CMC, TEC, JCH).
authors: Trina E
authors: TE
authors: Chang
authors: Harvard Medical School, Boston, MA (LS, SRB, SVM, CAM, JLJ, CMC, TEC, JCH); Department of Psychiatry, Massachusetts General Hospital, Boston, MA (LS, SRB, SVM, CAM, CMC, TEC, JCH).
authors: Jeff C
authors: JC
authors: Huffman
mesh_terms: D054058:Acute Coronary Syndrome / Q000523:psychology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000523:psychology; D005260:Female; D006331:Heart Diseases / Q000523:psychology*; D006333:Heart Failure / Q000523:psychology; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological / Q000175:diagnosis / Q000523:psychology*; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult