Suicidal Ideation and Risk Levels Among Primary Care Patients With Uncomplicated Depression

Herbert C. Schulberg; Pamela W. Lee; Martha L. Bruce; Patrick J. Raue; Jean J. Lefever; John W. Williams; Allen J. Dietrich; Paul A. Nutting

doi:10.1370/afm.377

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Figure 1.
Flow chart of participation in the trial.

IRB = institutional review board.

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Table 1.

Baseline Characteristics of Patients With Major Depression, Dysthymia, or Both, Stratified by Risk Level of Suicidal Ideation

		Risk Level*
Characteristic	Total (N = 405)	None (n = 259)	Low (n = 105)	Intermediate (n = 41)	P Value
HSCL-20 = 20 depression items from the Hopkins Symptom Checklist-90; MDD = major depressive disorder; GAD = generalized anxiety disorder; CAGE = Cut-down, Annoyed, Guilt, Eye-opener; SF-36 = Medical Outcomes Study 36-item Short-Form Health Survey; WHODAS = World Health Organization Disability Assessment Schedule II.
* None comprised 64% of total; low, 26% of total; and intermediate, 10% of total.
† Race or ethnicity other than non-Hispanic white.
‡ Poverty status was defined according to guidelines of the US Department of Health and Human Services, based on total annual household income (see The 2001 HHS Poverty Guidelines at http://aspe.hhs.gov/poverty/01poverty.htm).
§ HSCL-20 score range was 0 to 4; CAGE score range was 0 to 4; WHODAS scores were standardized to range from 0 (no impairment in last 30 days) to 1.0 (complete inability to perform throughout full 30 days).
Social and demographic
Female, %	80.25	82.63	78.10	70.73	.168
Age, mean (SD), y	41.94 (14.62)	42.50 (14.25)	43.57 (16.07)	34.17 (10.35)	.001
Education, mean (SD), y	13.24 (2.32)	13.32 (2.34)	13.15 (2.10)	12.98 (2.72)	.610
Ethnic minority,^† %	16.87	18.68	14.29	12.20	.420
Married, %	55.31	54.83	54.29	60.98	.740
Living with others , %	87.65	86.10	86.67	100.00	.040
Income level above poverty,^‡ %	78.76	81.45	77.78	64.10	.464
Paid employment, %	61.48	65.25	60.95	39.02	.006
Clinical ^§
HSCL-20 depression severity score, mean (SD)	2.01 (0.65)	1.86 (0.61)	2.23 (0.63)	2.39 (0.60)	.001
Depressive disorder
MDD only, %	78.52	77.22	82.86	75.61
MDD and dysthymia, %	19.26	19.31	17.14	24.39	.183
Dysthymia only, %	2.22	3.47	0.00	0.00
Symptoms of panic, %	20.54	20.08	19.23	26.83	.566
Symptoms of GAD, %	40.94	42.02	36.19	46.34	.449
CAGE score, mean (SD)	0.11 (0.39)	0.12 (0.41)	0.06 (0.27)	0.17 (0.54)	.236
SF-36 pain score, mean (SD)	1.43 (1.37)	1.26 (1.33)	1.68 (1.33)	1.85 (1.57)	.003
WHODAS disability scores, mean (SD)
Understand and communicate	0.32 (0.19)	0.30 (0.18)	0.35 (0.20)	0.40 (0.21)	.001
Getting around	0.24 (0.24)	0.20 (0.21)	0.30 (0.26)	0.31 (0.26)	.001
Self-care	0.16 (0.17)	0.14 (0.16)	0.18 (0.18)	0.26 (0.19)	.001
Getting along with people	0.30 (0.23)	0.26 (0.21)	0.36 (0.24)	0.38 (0.24)	.001
Life activities	0.41 (0.24)	0.37 (0.23)	0.47 (0.25)	0.47 (0.25)	<.001
Societal participation	0.41 (0.18)	0.37 (0.17)	0.46 (0.19)	0.52 (0.18)	.001

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Table 2.

Longitudinal Course of Suicidal Ideation and Risk Status in Patients Completing 3- and 6-Month Assessments

		At 3 Months		At 6 Months
Risk Level at Baseline	No. of Patients	None or Low No. (%)	Intermediate No. (%)	None or Low No. (%)	Intermediate No. (%)
None or low	268	265 (98.9)	3 (1.1)	261 (97.4)	7 (2.6)
Intermediate	25	19 (76.0)	6 (24.0)	20 (80.0)	5 (20.0)
Total	293	284 (96.9)	9 (3.1)	281 (95.9)	12 (4.1)

The Article in Brief

Suicidal Ideation and Risk Levels Among Primary Care Patients With Uncomplicated Depression

Herbert C. Schulberg, PhD, MSHyg , and colleagues

Background Primary care doctors play an important role in identifying and treating suicidal patients. Because depression is a major risk factor for suicide, this study examines rates of suicidal thoughts and risk levels for suicide among depressed primary care patients.

What This Study Found Using both a screening test and an interview, patients with depression were classified according to their risk for suicide. After 3 months and 6 months, almost all patients were at the same or a lower risk level.

Implications

The two-stage process in this study, using a screening test and interview, appears to be successful for assessing depressed patients� risk of suicide.