Physiotherapy theory and practice · 2025
Screening for depression misses people with suicidal ideation in patients with persistent musculoskeletal pain attending private physiotherapy.
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Vancampfort Davy, Van Damme Tine, Dankaerts Wim, Van Assche Dieter, Stubbs Brendon, McGrath Ryan L
Аннотация
BACKGROUND: Patients with persistent musculoskeletal pain face an increased risk of suicidal ideation, yet suicide risk is not routinely assessed in physiotherapy. Many primary care professionals use a two-stage screening approach, assessing depression first and only asking about suicide if depressive symptoms are present.
OBJECTIVE: This study examines the appropriateness of this approach in private musculoskeletal physiotherapy practicein Belgium and whether physiotherapists' observations of patients' distress align with patient self-reports.
METHODS: Four-hundred fifty patients completed thePatient Health Questionnaire-9 (PHQ-9), which includes the PHQ-2 and a suicide ideation item, while 84 physiotherapists completed an observer-report PHQ-2. Cross-tabulation and logistic regression compared observer ratings with patient-reported distress.
RESULTS: Mean scores on the observer-report and self-report PHQ-2 were similar (1.6 ± 1.6 vs. 1.6 ± 1.5, p = .79)and moderately correlated (r = 0.50, p < .001). Among patients reporting suicidal ideation (16.4%; n = 74), 41.9% (n = 31) scored below the PHQ-2 cutoff of 3, and 52.7% (n = 31) scored below on the observer-report version. A self-report PHQ-2 score of 3 or above was more strongly associated with suicidal ideation (odds ratio[OR] = 6.76; 95%CI = 3.96-11.53) than an observer-report PHQ-2 score of 3 or above (OR = 3.72; 95%CI = 2.21-6.28), though the latter had higher classification accuracy (83.6% vs. 76.2%). Physiotherapists were more likely to recommend professional support for patients with suicidal ideation (50.0% vs. 34.6%, p = .012), but coping advice did not differ by suicide risk.
CONCLUSION: Many patients with suicidal ideation did not meet the PHQ-2 depression threshold, highlighting the limitations of a two-stage screening approach in physiotherapy. Based on these findings, this approach is not recommended.
OBJECTIVE: This study examines the appropriateness of this approach in private musculoskeletal physiotherapy practicein Belgium and whether physiotherapists' observations of patients' distress align with patient self-reports.
METHODS: Four-hundred fifty patients completed thePatient Health Questionnaire-9 (PHQ-9), which includes the PHQ-2 and a suicide ideation item, while 84 physiotherapists completed an observer-report PHQ-2. Cross-tabulation and logistic regression compared observer ratings with patient-reported distress.
RESULTS: Mean scores on the observer-report and self-report PHQ-2 were similar (1.6 ± 1.6 vs. 1.6 ± 1.5, p = .79)and moderately correlated (r = 0.50, p < .001). Among patients reporting suicidal ideation (16.4%; n = 74), 41.9% (n = 31) scored below the PHQ-2 cutoff of 3, and 52.7% (n = 31) scored below on the observer-report version. A self-report PHQ-2 score of 3 or above was more strongly associated with suicidal ideation (odds ratio[OR] = 6.76; 95%CI = 3.96-11.53) than an observer-report PHQ-2 score of 3 or above (OR = 3.72; 95%CI = 2.21-6.28), though the latter had higher classification accuracy (83.6% vs. 76.2%). Physiotherapists were more likely to recommend professional support for patients with suicidal ideation (50.0% vs. 34.6%, p = .012), but coping advice did not differ by suicide risk.
CONCLUSION: Many patients with suicidal ideation did not meet the PHQ-2 depression threshold, highlighting the limitations of a two-stage screening approach in physiotherapy. Based on these findings, this approach is not recommended.