افکار مرگ و خودکشی گزارش شده توسط بیماران مبتلا به سرطان که آیتم "افکار خودکشی" PHQ-9 در طی غربالگری برای افسردگی را تایید می کنند

Patients with serious medical illnesses, such as cancer, are at increased risk of suicide but are also often facing death. The Patient Health Questionnaire-9 (PHQ-9) is widely used to screen patients for depression. It includes an item that asks about thoughts of death and hurting yourself (Item-9). Objective To describe the nature of thoughts of death and suicide reported in clinical interviews carried out to further assess suicidal ideation of cancer outpatients who had endorsed the “suicidal thoughts item” (Item-9) of the PHQ-9 during routine depression screening. Method Secondary analysis of anonymized service data (with ethical approval) derived from the routine clinical administration of self-report questionnaires and telephone interviews to outpatients attending a Cancer Centre in the UK. Results Complete data were available on 330/463 (71%) of patients who had endorsed Item-9. In a subsequent structured telephone interview, approximately one-third of these patients denied any thoughts that they would be better off dead, another third acknowledged having thoughts that they would be better off dead, but not of suicide, and the remaining third reported clear thoughts of committing suicide. Conclusion Only one-third of cancer outpatients who endorse the “suicidal thoughts item” of the PHQ-9 report suicidal thoughts at a subsequent interview. Services planning to set up depression screening with the PHQ-9 need to carefully consider the relative benefits and burden to their service and patients of including Item-9 and interviewing all those who endorse it.

Patients with severe medical illnesses such as cancer are at increased risk of suicide.1 The Patient Health Questionnaire-9 (PHQ-9) is widely used to screen medical patients for depression and includes an item (Item-9) that asks how frequently the respondent has been bothered by “thoughts that you would be better off dead, or of hurting yourself in some way” over the preceding 2 weeks, scored from 0, ‘not at all’ to 3, ‘nearly every day’.2 We have previously reported that 8% of a large sample of cancer outpatients endorsed this item (scored more than 0) on routine screening with the PHQ-9.3 However, interpreting these results is complicated by the fact that patients who have a life-threatening illness such as cancer may be preoccupied with thoughts of death rather than suicide. Two questions, therefore, arose from this initial study: First, can we use patients' scores on Item-9 to predict who actually does have suicidal thoughts, rather than simply thoughts of death and dying? Second, what do cancer outpatients really mean when they endorse Item-9; that is, what kinds of thoughts do they have about death and suicide? We addressed the first of these questions in a previous study of the current sample.4 We found that patients with higher scores on Item-9 were more likely to have suicidal thoughts. However, we were unable to provide a cut-off score above which patients require further clinical assessment because nearly a quarter of patients who had a low score (score of one) reported suicidal thoughts at interview. This paper addresses the second of these questions by describing in detail the nature of thoughts of death and suicide reported at interview by cancer outpatients who had endorsed Item-9 of the PHQ-9 during routine depression screening at the cancer clinic.