IDENTIFYING SUICIDAL IDEATION IN GENERAL MEDICAL PATIENTS

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.