Aims: Depression screeners in adolescents and young adults (AYAs) with diabetes may under-identify patients at risk for suicide. We examined prevalence of suicidal ideation (SI) using the Patient Health Questionnaire 9 (PHQ-9) depression screener and an in-person safety assessment conducted by a pediatric psychologist.
Methods: Participants included 104 AYAs with diabetes seen for their first Diabetes Transition Clinic appointment. Participants were administered the PHQ-9 and completed a safety assessment with a pediatric psychologist. The safety assessment included questions about AYA’s recent history of passive/active SI, plan, or intent (suicidal risk). Safety assessment responses were dichotomized to represent presence or absence of suicidal risk. Analyses included rates of positive depression screens and comparison of SI risk based on response to PHQ-9 SI question (i.e., “thoughts that you’d be better off dead or thoughts of hurting yourself in some way” over the past 2 weeks) and the safety assessment.
Results: On PHQ-9 screening, 19% of AYAs (n=21; age 20.3 + 1.0 years, 66.7% female) reported moderate to severe symptoms of depression and 5 reported SI in the past 2 weeks. The safety assessment identified 5 AYAs as at suicidal risk. The SI sensitivity rate for the PHQ-9 was 60% and specificity rate was 98%. The PHQ-9 misclassified 40% of AYAs as not at risk that were identified by the safety assessment and over-identified 2% of patients as at risk not corroborated by the safety assessment.
Conclusion: Moderate to severe symptoms of depression are common in AYAs with diabetes. Results suggest the PHQ-9 as a proxy for identifying SI may result in under-identification of some patients who may otherwise be at risk for suicide. The need for consistent identification of suicidality is critical. Besides better assessment tools for SI, this study reinforces the value of an embedded pediatric psychologist as a part of a multidisciplinary care team to address the needs of this unique population.
A. Moss: None. A.J. Roberts: None. J. Yi-Frazier: None. K.L. Read: None. C. Pihoker: None. I.B. Hirsch: Consultant; Self; Abbott, Bigfoot Biomedical, Roche Diabetes Care. Research Support; Self; Medtronic, Omnipod. K.W. Weaver: None. C. Taplin: None. F. Malik: None.