L. Cooperpatrick et al., IDENTIFYING SUICIDAL IDEATION IN GENERAL MEDICAL PATIENTS, JAMA, the journal of the American Medical Association, 272(22), 1994, pp. 1757-1762
Objectives.-To describe characteristics of general medical patients wi
th suicidal ideation and to develop an efficient clinical strategy for
identifying these patients. Design.-Cross-sectional analysis of data
without intervention. Setting.-A representative sample of community re
spondents interviewed as part of the National Institute of Mental Heal
th Epidemiologic Catchment Area surveys. Subjects.-A total of 6041 ind
ividuals who reported receiving care in general medical settings in th
e 6 months preceding the baseline interview. Main Outcome Measure.-Sui
cidal ideation within the year preceding the baseline interview. Resul
ts.-A total of 154 patients(2.6%) had experienced suicidal thoughts wi
thin the previous year. In multivariate analyses, the following sociod
emographic factors were significantly associated with having suicidal
ideation: being white (odds ratio [OR], 2.8; P<.001) relative to Afric
an American, separated or divorced (OR, 1.8; P=.03) relative to marrie
d, and aged 18 to 30 years (OR, 2.3; P=.02) or aged 31 to 50 years (OR
, 2.1; P=.03) relative to those older than 65 years. Gender, education
al level, and socioeconomic status were not statistically associated w
ith suicidal ideation. Psychiatric disorders significantly associated
with suicidal ideation were major depression (OR, 10.3; P<.001),panic
disorder (OR, 5.2; P<.001), alcohol disorder (OR, 2.0; P=.04), and pho
bic disorder (OR, 1.6; P=.02) within the previous year. However, only
34% of respondents with suicidal ideation met criteria for major depre
ssion. With the aid of stepwise logistic regression, a four-item scree
ning questionnaire, the Suicidal Ideation Screening Questionnaire, was
developed to predict patients with suicidal ideation. Likelihood rati
os for suicidal ideation increased from 0.21 to 32.8 with more positiv
e responses to questions concerning symptoms of hopelessness, guilt, d
epressed mood, and sleep disturbances. Conclusions.-If the results fro
m the four-item screen are reproduced in a clinical setting, general m
edical patients with a high likelihood for suicidal ideation may be id
entified with a brief screening questionnaire. This screen would have
greater sensitivity than would be achieved by assessing suicidal ideat
ion only in those patients who meet criteria for a distinct psychiatri
c disorder.