Improving Suicide Risk Screening to Identify the Highest Risk Patients: Results From the PRImary Care Screening Methods (PRISM) Study

Article Figures & Data

Table 1.

Participant Characteristics (N = 2,744)

Characteristic	Data
Age, mean (SD), y	40.4 (19.6)
Sex, No. (%)
Male	1,380 (51.3)
Female	1,279 (47.5)
Other	9 (0.3)
Prefer not to answer	17 (0.6)
Missing	59 (2.2)
Race, No. (%)^{^a}
American Indian or Alaska Native	123 (4.6)
Asian	115 (4.3)
Black or African American	506 (18.8)
Pacific Islander or Native Hawaiian	44 (1.6)
White	1,811 (67.3)
Other	272 (10.1)
Hispanic or Latino ethnicity, No. (%)
Yes	415 (15.4)
No	2,199 (81.7)
Other	20 (0.7)
Prefer not to answer	51 (1.9)
Missing	59 (2.2)
Military service, No. (%)
Yes, current member	1,652 (61.4)
Yes, in the past	451 (16.8)
No	580 (21.6)
Missing	61 (2.1)
Branch of service, No. (%)^{^b}
Air Force	236 (11.2)
Army	408 (19.4)
Coast Guard	3 (0.1)
Marine Corps	283 (13.5)
Navy	1,171 (55.7)

Table 2.

Performance of Suicide Risk Screening Methods as Indicators of Suicidal Behavior Among Primary Care Patients

Screening results^{^a}	TP	FP	TN	FN	FP:TP	Sens	Spec	PPV	NPV
30 days postbaseline
PHQ-2 positive	9	468	2104	4	52.0	0.692	0.818	0.019	0.998
PHQ-2 positive + PHQ-9 positive	7	170	2402	6	24.3	0.538	0.934	0.040	0.998
PHQ-2 positive + PHQ-9 positive + SCS item 8 positive	7	114	2458	6	16.3	0.538	0.956	0.058	0.998
PHQ-2 positive + PHQ-9 positive + SCS item 13 positive	7	92	2480	6	13.1	0.538	0.964	0.071	0.998
PHQ-2 positive + PHQ-9 positive + SCS item 16 positive	5	68	2504	8	13.6	0.385	0.974	0.068	0.997
90 days postbaseline
PHQ-2 positive	16	461	2098	10	28.8	0.615	0.820	0.034	0.995
PHQ-2 positive + PHQ-9 positive	13	164	2395	13	12.6	0.500	0.936	0.073	0.995
PHQ-2 positive + PHQ-9 positive + SCS item 8 positive	13	108	2451	13	8.3	0.500	0.958	0.107	0.995
PHQ-2 positive + PHQ-9 positive + SCS item 13 positive	12	87	2471	15	7.3	0.444	0.966	0.121	0.994
PHQ-2 positive + PHQ-9 positive + SCS item 16 positive	10	63	2494	17	6.3	0.370	0.975	0.137	0.993

FN = false negatives; FP = false positives; NPV = negative predictive value; PHQ-2 = 2-item patient health questionnaire; PHQ-9 = 9-item patient health questionnaire; PPV = positive predictive value; Sens = sensitivity; Spec = specificity; SCS = Suicide Cognitions Scale; TN = true negatives; TP = true positives.
↵^aA positive screen on the PHQ-2 corresponds to a total score of 3 or higher, a positive screen on the PHQ-9 corresponds to a score of 1 or higher on item 9, and a positive screen on SCS items 8, 13, and 16 corresponds to a score of 2 or higher on each item.

Supplemental appendix, tables 1-5

Bryan.pdf -
Supplemental appendix; tables 1-5
In Brief

Improving Suicide Risk Screening to Identify the Highest Risk Patients: Results From the PRImary Care Screening Methods (PRISM) Study

Craig J. Bryan and colleagues

Background Researchers from academia and the U.S. military sought to determine if suicide risk screening can be meaningfully improved to better identify highest-risk patients. Patients eligible to receive medical treatment from the U.S. Department of Defense medical system were recruited from six military primary care clinics in five military installations across the country.

What This Study Found Adding one of three Suicide Cognitions Scale (SCS) items to the Patient Questionaarie (PHQ-9) self report measure during routine primary care clinical visits improved the accuracy of identifying those patients who were at the highest risk of suicidal behavior within a month of screening positive.

Implications

One byproduct of augmenting the PHQ-9 is a potential reduction in unnecessary treatment and/or misallocated resources — a benefit to both patients and physicians, considering a majority of patients who screen positively on the PHQ-9 suicide risk item do not attempt or die by suicide.