Use of the Patient Health Questionnaire-9 and a Detailed Suicide Evaluation in Determining Imminent Suicidality in Distressed Patients With Cardiac Disease

Background: The risk of suicide is elevated in patients with cardiac disease in comparison with the general population. Objective: In distressed cardiac inpatients, we explored the use of Item 9 of the Patient Health Questionnaire-9, which inquires about thoughts of death or suicide, and a detailed suicide evaluation (DSE) triggered by positive responses to Item 9 as means of assessing suicide. Methods: Among cardiac inpatients endorsing current emotional distress, we recorded the prevalence of positive responses to item 9, gathered information about outcomes and time spent completing the DSE, and examined the frequency of imminent suicidality identified by the DSE among Item 9-positive patients. Results: Among 366 patients, 77 (21%) answered affirmatively to Item 9. All DSEs were successfully completed but consumed 17 clinician hours. Among the 71 patients receiving the DSE, 2 (0.5% of total sample; 2.8% of Item 9-positive patients) were imminently suicidal (i.e., had intent or plan). Conclusion: Nearly I in 4 patients had a positive response to Item 9, but very few had imminent suicidality; the DSE was easy to use and acceptable to patients but time consuming. A more narrowly focused alternative to Item 9 may more accurately predict imminent,suicidality and reduce the burden of further detailed suicide screening.