title: Risk of suicide attempt and suicide death following completion of the Patient Health Questionnaire depression module in community practice.
abstract: OBJECTIVE
  To examine the association between thoughts of death or self-harm reported on item 9 of the Patient Health Questionnaire (PHQ) depression module and the risk of suicide attempt or suicide death over the following 2 years.
  
  
  METHODS
  In 4 health care systems participating in the Mental Health Research Network, electronic records identified 509,945 adult outpatients completing 1,228,308 PHQ depression questionnaires during visits to primary care, specialty mental health, and other outpatient providers between January 1, 2007 and December 31, 2012. 9,203 nonfatal suicide attempts were identified using health system records of inpatient or outpatient encounters for self-inflicted injury. 484 suicide deaths were identified using cause-of-death codes from state mortality data.
  
  
  RESULTS
  Cumulative hazard of suicide attempt during 2 years ranged from approximately 0.5% among those reporting thoughts of death or self-harm "not at all" to 3.5% among those reporting such thoughts "nearly every day." Cumulative hazard of suicide death during 2 years ranged from approximately 0.04% among those responding "not at all" to 0.19% among those responding "nearly every day." The excess hazard associated with thoughts of death or self-harm declined with time, but remained 2- to 5-fold higher for at least 18 months. Nevertheless, 39% of suicide attempts and 36% of suicide deaths within 30 days of completing a PHQ occurred among those responding "not at all" to item 9.
  
  
  CONCLUSIONS
  In community practice, response to PHQ item 9 is a strong predictor of suicide attempt and suicide death over the following 2 years. For patients reporting thoughts of death or self-harm, suicide prevention efforts must address this enduring vulnerability.
authors.affiliation: Group Health Research Institute, 1730 Minor Ave, Seattle, WA 98101 simon.g@ghc.org.
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Simon
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Coleman
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Rossom
authors.forename: Arne
authors.initials: A
authors.lastname: Beck
authors.forename: Malia
authors.initials: M
authors.lastname: Oliver
authors.forename: Eric
authors.initials: E
authors.lastname: Johnson
authors.forename: Ursula
authors.initials: U
authors.lastname: Whiteside
authors.forename: Belinda
authors.initials: B
authors.lastname: Operskalski
authors.forename: Robert B
authors.initials: RB
authors.lastname: Penfold
authors.forename: Susan M
authors.initials: SM
authors.lastname: Shortreed
authors.forename: Carolyn
authors.initials: C
authors.lastname: Rutter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D012306:Risk; D013405:Suicide / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult