Comparison of electronic screening for suicidal risk with the Patient Health Questionnaire Item 9 and the Columbia Suicide Severity Rating Scale in an outpatient psychiatric clinic

Background
Patient-reported data can improve clinical care, including identifying patients who are at risk for suicide.
Methods
In a tertiary care, psychiatric outpatient clinic, we compared computerized self-assessments of suicidal risk based on item 9 of the Patient Health Questionnaire-9and an electronic version of the Columbia Suicide Severity Rating Scale (C-SSRS), using retrospective medical record review of clinical psychiatric assessments as the reference standard. We also surveyed patients׳ attitudes about participating in the process. We compared prevalence of suicidal risk rates by the 3 assessment methods as well as their sensitivity, specificity, and predictive value.
Results
Observed prevalence of positive suicidal risk screenings differed significantly, ranking (1) Patient Health Questionnaire-9 item 9, 24% (343/1416; 95% CI: 22%–26%) < (2) C-SSRS, 6.0% (85/1416; 95% CI: 5.0%–7.4%) < (3) clinical assessment, 1.4% (20/1416; 95% CI: 0.9%–2.2%). The sensitivity of Patient Health Questionnaire-9 item 9 was 92% (78/85; 95% CI: 86%–98%) and the specificity was 81% (1107/1376; 95% CI: 78%–82%). The sensitivity of the C-SSRS was 95.0% (19/20; 95% CI: 75%–100%) and the specificity was 95% (1330/1396; 95% CI: 94%–96%). Of 100 patients surveyed, the screening was well accepted, with some concerns about confidentiality and adequate clinical follow-up.
Conclusions
As expected, Patient Health Questionnaire-9 item 9 generated much higher rates of apparently false-positive findings than the C-SSRS did, when compared with clinical assessment. C-SSRS backed with timely clinical assessment may be a useful and efficient method of screening for suicidal risk, provided that adequate, immediate clinical follow-up is available.