ImportanceGiven that the Patient Health Questionnaire (PHQ) item 9 is commonly used to screen for risk of self-harm and suicide, it is important that clinicians recognize circumstances when at-risk adolescents may go undetected.ObjectiveTo understand characteristics of adolescents with a history of depression who do not endorse the PHQ item 9 before a near-term intentional self-harm event or suicide.Design, Setting, and ParticipantsThis was a retrospective cohort study design using electronic health record and claims data from January 2009 through September 2017. Settings included primary care and mental health specialty clinics across 7 integrated US health care systems. Included in the study were adolescents aged 13 to 17 years with history of depression who completed the PHQ item 9 within 30 or 90 days before self-harm or suicide. Study data were analyzed September 2022 to April 2023.ExposuresDemographic, diagnostic, treatment, and health care utilization characteristics.Main Outcome(s) and Measure(s)Responded “not at all” (score = 0) to PHQ item 9 regarding thoughts of death or self-harm within 30 or 90 days before self-harm or suicide.ResultsThe study included 691 adolescents (mean [SD] age, 15.3 [1.3] years; 541 female [78.3%]) in the 30-day cohort and 1024 adolescents (mean [SD] age, 15.3 [1.3] years; 791 female [77.2%]) in the 90-day cohort. A total of 197 of 691 adolescents (29%) and 330 of 1024 adolescents (32%), respectively, scored 0 before self-harm or suicide on the PHQ item 9 in the 30- and 90-day cohorts. Adolescents seen in primary care (odds ratio [OR], 1.5; 95% CI, 1.0-2.1; P = .03) and older adolescents (OR, 1.2; 95% CI, 1.0-1.3; P = .02) had increased odds of scoring 0 within 90 days of a self-harm event or suicide, and adolescents with a history of inpatient hospitalization and a mental health diagnosis had twice the odds (OR, 2.0; 95% CI, 1.3-3.0; P = .001) of scoring 0 within 30 days. Conversely, adolescents with diagnoses of eating disorders were significantly less likely to score 0 on item 9 (OR, 0.4; 95% CI, 0.2-0.8; P = .007) within 90 days.Conclusions and RelevanceStudy results suggest that older age, history of an inpatient mental health encounter, or being screened in primary care were associated with at-risk adolescents being less likely to endorse having thoughts of death and self-harm on the PHQ item 9 before a self-harm event or suicide death. As use of the PHQ becomes more widespread in practice, additional research is needed for understanding reasons why many at-risk adolescents do not endorse thoughts of death and self-harm.

中文翻译：

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在自残或自杀之前不通过患者健康调查问卷认可风险的青少年

重要性鉴于患者健康问卷 (PHQ) 第 9 项通常用于筛查自残和自杀风险，因此临床医生认识到高危青少年可能未被发现的情况非常重要。 目的了解有自残和自杀史的青少年的特征在近期故意自残事件或自杀之前不认可 PHQ 项目 9 的抑郁症患者。设计、设置和参与者这是一项回顾性队列研究设计，使用 2009 年 1 月至 2017 年 9 月的电子健康记录和索赔数据。设置包括遍布美国 7 个综合医疗保健系统的初级保健和心理健康专科诊所。该研究包括有抑郁症病史的 13 至 17 岁青少年，他们在自残或自杀前 30 或 90 天内完成了 PHQ 第 9 项。研究数据于 2022 年 9 月至 2023 年 4 月进行分析。暴露人口、诊断、治疗和医疗保健利用特征。主要结果和措施 对 PHQ 第 9 项有关想法的回答“完全不”（分数 = 0）自残或自杀前 30 或 90 天内死亡或自残。 结果该研究包括 30 天队列中的 691 名青少年（平均 [SD] 年龄，15.3 [1.3] 岁；541 名女性 [78.3%]）和 1024 名青少年90 天队列中的青少年（平均 [SD] 年龄，15.3 [1.3] 岁；791 名女性 [77.2%]）。在 30 天和 90 天队列中，691 名青少年中有 197 名 (29%) 和 1024 名青少年中有 330 名 (32%) 在自残或自杀前 PHQ 第 9 项得分为 0。青少年接受初级保健（比值比 [OR]，1.5；95% CI，1.0-2.1；磷= .03）和年龄较大的青少年（OR，1.2；95% CI，1.0-1.3；磷= .02）在自残事件或自杀后 90 天内得分为 0 的几率增加，有住院史和心理健康诊断的青少年的几率是其两倍（OR，2.0；95% CI，1.3- 3.0；磷= .001) 30 天内得分为 0。相反，被诊断为饮食失调的青少年在第 9 项上得分为 0 的可能性显着降低（OR，0.4；95% CI，0.2-0.8；磷= .007) 在 90 天内。结论和相关性研究结果表明，年龄较大、住院心理健康经历或在初级保健中接受筛查与高危青少年不太可能认可死亡和自我保护的想法有关。在发生自残事件或自杀死亡之前，对 PHQ 第 9 项的伤害。随着 PHQ 在实践中的使用变得越来越广泛，需要进行更多研究来了解许多高危青少年不支持死亡和自残想法的原因。