title: Suicidal ideation in persons with neurological conditions: prevalence, associations and validation of the PHQ-9 for suicidal ideation.
abstract: Our primary aim was to validate the Patient Health Questionnaire (PHQ)-9 as a screening tool for suicidal ideation (SI).
  
  
  
  Persons with epilepsy (n=188), migraine (n=208), multiple sclerosis (n=151), and stroke (n=122) completed questionnaires (e.g., PHQ-9) and the structured clinical interview for DSM-IV (SCID). Logistic regression was used to examine factors associated with SI [odds ratios (ORs) with 95% confidence intervals (CIs)]. The diagnostic accuracy of the PHQ-9 in identifying SI [sensitivity (Se), specificity (Sp), positive and negative predictive value (PPV and NPV)] was validated against the SCID.
  
  
  
  The 2-week prevalence of SI ranged from 5.7% (stroke) to 12.7% (epilepsy). Factors most strongly associated with SI were depression [OR ranging from 14.6 (migraine) to 38.6 (stroke)] and anxiety [OR ranging from 8.6 (migraine) to 15.3 (epilepsy)] (see text for 95% CI). The PHQ-9 had good Se for SI in epilepsy (90%) and migraine (75.0%). PPV was poor while Sp and NPV were >90% for every condition.
  
  
  
  Screening for depression and anxiety is important in view of their strong association with SI. The PHQ-9 may be considered as a screening tool for SI, although it should not be relied on solely in view of its suboptimal PPV.
authors.affiliation: Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 2T9, Canada.
authors.forename: Kristianne Chelsea
authors.initials: KC
authors.lastname: Altura
authors.affiliation: Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 2T9, Canada; Department of Psychiatry and Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 2T9, Canada.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Patten
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, MB R3T 2N2, Canada.
authors.forename: Kirsten M
authors.initials: KM
authors.lastname: Fiest
authors.affiliation: Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 2T9, Canada.
authors.forename: Callie
authors.initials: C
authors.lastname: Atta
authors.affiliation: Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 2T9, Canada; Department of Psychiatry and Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 2T9, Canada.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Bulloch
authors.affiliation: Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 2T9, Canada. Electronic address: nathalie.jette@albertahealthservices.ca.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Jetté
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis*; D003863:Depression / Q000175:diagnosis*; D004827:Epilepsy / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000523:psychology*; D009103:Multiple Sclerosis / Q000523:psychology*; D000073222:Patient Health Questionnaire / Q000592:standards*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D020521:Stroke / Q000523:psychology*; D059020:Suicidal Ideation; D055815:Young Adult
keywords: Depression; Diagnostic accuracy; Epidemiology; Mental health; Suicide