Which PHQ-9 Items Can Effectively Screen for Suicide? Machine Learning Approaches

Int J Environ Res Public Health. 2021 Mar 24;18(7):3339. doi: 10.3390/ijerph18073339.

Abstract

(1) Background: The Patient Health Questionnaire-9 (PHQ-9) is a tool that screens patients for depression in primary care settings. In this study, we evaluated the efficacy of PHQ-9 in evaluating suicidal ideation (2) Methods: A total of 8760 completed questionnaires collected from college students were analyzed. The PHQ-9 was scored in combination with and evaluated against four categories (PHQ-2, PHQ-8, PHQ-9, and PHQ-10). Suicidal ideations were evaluated using the Mini-International Neuropsychiatric Interview suicidality module. Analyses used suicide ideation as the dependent variable, and machine learning (ML) algorithms, k-nearest neighbors, linear discriminant analysis (LDA), and random forest. (3) Results: Random forest application using the nine items of the PHQ-9 revealed an excellent area under the curve with a value of 0.841, with 94.3% accuracy. The positive and negative predictive values were 84.95% (95% CI = 76.03-91.52) and 95.54% (95% CI = 94.42-96.48), respectively. (4) Conclusion: This study confirmed that ML algorithms using PHQ-9 in the primary care field are reliably accurate in screening individuals with suicidal ideation.

Keywords: PHQ-9; machine learning; screening; suicide.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Depression / diagnosis
  • Humans
  • Machine Learning
  • Mass Screening
  • Patient Health Questionnaire*
  • Psychiatric Status Rating Scales
  • Suicidal Ideation*
  • Surveys and Questionnaires