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Screening for Suicide Ideation among Older Primary Care Patients

Departments of Psychiatry and Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario and Lawson Health Research Institute, London, Canada (MJH)
Geriatric Psychiatry Program, Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (PRD, JML)
Division of General Internal Medicine, University of California, San Francisco (MDF)

Correspondence: Corresponding author: Marnin J. Heisel, PhD, Department of Psychiatry, The University of Western Ontario, London Health Sciences Centre, 375 South Street, Room #5054, London, Ontario, N6A 4G5, Canada (E-mail: Marnin.Heisel{at}lhsc.on.ca)

Objectives:Older adults have high rates of suicide and typically seek care in primary medical practices. Older adults often do not directly or spontaneously report thoughts of suicide, which can impede suicide prevention efforts. Therefore, the use of additional approaches to suicide risk detection is needed, including the use of screening tools. The objective of this study was to assess whether brief screens for depression have acceptable operating characteristics in identifying suicide ideation among older primary care patients and to examine potential sex differences in the screen's accuracy.

Methods: We administered the 15-item Geriatric Depression Scale (GDS), which includes a 5-item GDS subscale (GDS-SI) designed to screen for suicide ideation, to a cross-sectional cohort of 626 primary care patients (235 men, 391 women) 65 years of age or older in the Northeastern United States. We assessed presence of suicide ideation with items from the Hamilton Rating Scale for Depression and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

Results: Patients expressing suicide ideation (n = 69) scored higher on the GDS and GDS-SI than those who did not (n = 557). A GDS cut score of 4 maximized sensitivity (0.754) and specificity (0.815), producing an area under the curve of 0.844 (P < .001) and positive and negative predictive values of 0.335 and 0.964, respectively. Optimal cut scores were 5 for men and 3 for women. A GDS-SI cut score of 1 was optimal for the total sample and for both men and women.

Conclusions: The GDS and GDS-SI accurately identify older patients with suicide ideation. Research is needed to examine their acceptability and barriers to routine use in primary care.

Key Words: Suicide Ideation • Death Ideation • Geriatrics • Depression Screening

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