Screening for Suicide Ideation among Older Primary Care Patients

Article Figures & Data

Table 1.

Geriatric Depression Scale-Suicide Ideation Screening Items*

GDS Item No.	Item
3	Do you feel that your life is empty?
7	Do you feel happy most of the time?
11	Do you think it is wonderful to be alive?
12	Do you feel pretty worthless the way you are now?
14	Do you feel that your situation is hopeless?

* Scoring for the Geriatric Depression Scale (GDS) items involves assigning a response of “yes” or “no” to each item. These items were drawn from the GDS.²⁹

Table 2.

Demographic and Clinical Characteristics of Study Participants (n = 626)

Variable	n (%)	Mean (Standard Deviation)	Range
Age (in years)		75.02 (6.78)	65–95
Sex
Men	235 (38)
Women	391 (62)
Marital Status
Married	326 (53)
Separated/Divorced	65 (11)
Widowed	193 (31)
Single/Never Married	31 (5)
Missing Data	11
Race
White	584 (93)
Black	29 (5)
Other	11 (2)
Don’t Know	2 (<1)
Lives Alone	217 (36)
Years of Education		14 (2.63)
Employment Status
Retired	516 (82)
Unemployed/Disability Benefits	10 (2)
Part- or Full-Time Employment	90 (14)
Part- or Full-Time Student	3 (<1)
Missing Data	7
CIRS		7.61 (3.90)	1–68
IADL		1.96 (3.81)	0–22
PSMS		1.61 (2.32)	0–20
Number of prescription medications		7.46 (3.67)	0–24
Presence of medical condition
Arthritis	400 (64)
Cancer	68 (11)
Neurologic disorder	132 (21)
COPD	86 (14)
Hypothyroidism	133 (21)
Decreased hearing	168 (27)
Decreased vision	46 (7)
Diabetes	117 (19)
Hypertension	453 (72)
Cardiovascular disease	181 (29)

CIRS, Cumulative Illness Rating Scale total scores; IADL, Instrumental Activities of Daily Living Scale; PSMS, Physical Self-Maintenance Scale; COPD, chronic obstructive pulmonary disease.

Table 3.

Operating Characteristics of Geriatric Depression Scale Cut scores with Respect to Patient Suicide Ideation Status, by Sex

GDS Cut score	Total Sample				Men				Women
GDS Cut score	Sensitivity^*	Specificity	PPV	NPV	Sensitivity^‡	Specificity	PPV	NPV	Sensitivity^‖	Specificity	PPV	NPV
2	0.884	0.557	0.198	0.975	0.900	0.586	0.168	0.984	0.878	0.538	0.214	0.968
3	0.797	0.722	0.262	0.966	0.900	0.753	0.254	0.988	0.755	0.702	0.266	0.952
4	0.754	0.815	0.335	0.964	0.850	0.833	0.321	0.984	0.714	0.804	0.343	0.952
5	0.652	0.878	0.398	0.953	0.850	0.916	0.486	0.985	0.571	0.854	0.359	0.933
6	0.551	0.910	0.432	0.942	0.650	0.940	0.500	0.967	0.510	0.892	0.403	0.927

GDS-SI Cut score	Sensitivity^†	Specificity	PPV	NPV	Sensitivity^§	Specificity	PPV	NPV	Sensitivity^¶	Specificity	PPV	NPV
1	0.797	0.804	0.335	0.970	0.800	0.809	0.281	0.978	0.796	0.801	0.364	0.965
2	0.551	0.928	0.487	0.943	0.650	0.949	0.542	0.967	0.510	0.915	0.463	0.929
3	0.348	0.978	0.667	0.924	0.500	0.986	0.813	0.968	0.286	0.974	0.609	0.905

Bold numbers reflect suggested cut scores. We tested the significance of the receiver operating characteristic curves by computing the area under the curves produced by plotting sensitivity against 1 minus specificity, for suicide ideators (N = 69; 20 men and 49 women) vs non ideators (N = 557; 215 men and 342 women); AUCs were compared against a null hypothesis of 50% coverage using a Wilcoxon rank sum test.
* Area under the curve (AUC), 0.844; standard error, 0.026; 95% CI, 0.793–0.896.
† AUC, 0.834; standard error, 0.031; 95% CI, 0.774–0.894.
‡ AUC, 0.902; standard error, 0.047; 95% CI, 0.810–0.994.
§ AUC, 0.857; standard error, 0.057; 95% CI, 0.745–0.969.
‖ AUC, 0.814; standard error, 0.032; 95% CI, 0.752–0.877.
¶ AUC, 0.822; standard error, 0.036; 95% CI, 0.751–0.893.
PPV, positive predictive value; NPV, negative predictive value; GDS, Geriatric Depression Scale (α = 0.81 total; α = 0.82 for men and α = 0.80 for women); GDS-SI, 5-item Geriatric Depression Scale-Suicide Ideation screen (α = 0.68 total; α = 0.73 for men and α = 0.65 for women).