Inadequacy of the PHQ-2 Depression Screener for Identifying Suicidal Primary Care Patients

Introduction: The Patient Health Questionnaire-2 (PHQ-2) depression screener has been praised for its brevity and ability to identify depressed primary care patients. Additionally, it is often used as the first of a two-step screening process for suicide risk. Despite its decent performance as a depression screener, the PHQ-2 cannot be assumed to be an adequate screener for suicide risk. In the present study, we examine the utility of the PHQ-2 for identifying suicidal patients. Method: We examined data from 548 adult primary care patients at a Federally Qualified Health Center in the mid-Southern region of the United States who completed the PHQ-2 as part of the full administration of the Patient Health Questionnaire-9 (PHQ-9). Results: Cross-tabulation analyses revealed 22 of the 157 (14.0%) patients endorsing suicidal ideation fell below the conventional clinical cutoff of 3 on the PHQ-2. Logistic regression analyses indicated a positive screen on the PHQ-2 did not improve explanation of suicidal ideation beyond the base model, and only 3 items from the first 8 PHQ-9 questions (depressed mood, feeling like a failure, and psychomotor retardation/agitation) were significant explanatory variables for suicidal ideation. Discussion: Providers should consider asking about suicide directly, rather than relying on depression screeners to identify suicidal patients. We also recommend providers pay particular attention to any indication that patients feel like a failure or like they have let their loved ones down, in addition to endorsement of depressed mood.