Comparison of screening for suicidal ideation in the year prior to death by suicide

Background: Screening for suicidality with a Patient Health Questionnaire-9 (PHQ-9) at our institution has previously been reported to occur 37.9% in the year prior to suicide death. Our institution has initiated practice changes aimed at increasing this screening rate. Methodology: We reviewed patient records who died by suicide (cases) between January 16, 2013 and December 31, 2020. We compared these to age and gender matched controls for completion of PHQ-9 recorded in the electronic medical record in the year prior to suicide death or year prior to the date of the case matched death. We looked at whether there was evidence of suicidal ideation evidenced by a score higher than zero for question 9. Results: Cases were more likely than controls to have a PHQ-9 done prior to death though only 28.4% of cases had a PHQ-9 completed. For cases who had a primary care visit done in the year before death, 64/93 (68.9%) had a PHQ-9 done compared to 43/143 (30%) of controls (p<0.0001). Cases were significantly more likely than controls to have a score greater than 0 for question #9 (46.3% vs 16.4%, p<0.0001). Limitations: The data was collected from primary care visits at a single large institution and was from a highly structured dataset without a manual review of every visit. Conclusions: Screening for suicidal ideation in patients with suicide risk factors was improved through institutional based practice changes and overall screening was high for at-risk patients based on depression history or taking depression medications.