Articlebronze2010

Screening for Suicide Ideation among Older Primary Care Patients

Marnin J. Heisel · Paul R. Duberstein · Jeffrey M. Lyness

82 citations0/0 files storedThe Journal of the American Board of Family Medicine

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Suicide and Self-Harm Studies Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Mental Health Treatment and Access

Abstract

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.

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References

2013Diagnostic and Statistical Manual of Mental Disorders 2015Older Adults' Reasons for Using Technology while Aging in Place 1999Validation and Utility of a Self-report Version of PRIME-MD The PHQ Primary Care Study 2002The world report on violence and health 2024Diagnostic and Statistical Manual of Mental Disorders 1988A Structured Interview Guide for the Hamilton Depression Rating Scale 2002Contact With Mental Health and Primary Care Providers Before Suicide: A Review of the Evidence 2002World Report on Violence and Health, World Health Organization

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2015Issues in research on aging and suicide 2021Accuracy of the Geriatric Depression Scale (GDS)-4 and GDS-5 for the screening of depression among older adults: A systematic review and meta-analysis

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