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Active Thoughts Of Self Harm Among Patients In A Hand Surgery Clinic
Roland A. Zama, BS1,2, Richard Hum, BS
1,2, Yanbao Xiong, MS
1, Gabriel Yohe, MS
1, Aviram M. Giladi, MD, MS
1.
1The Curtis National Hand Center, Baltimore, MD, USA,
2Georgetown University School of Medicine, Washington, DC, USA.
PURPOSE: Depression is commonly comorbid with conditions of chronic pain and, as such, has a profound impact on hand surgery patients, including aspects of chronic pain, delayed return to work, surgical outcome dissatisfaction, and perceived disability. A subset of patients with depression have active suicidal thoughts or thoughts of self-harm; however, comprehensive data are scarce addressing this issue among patients in a hand surgery clinic. The primary objective of this study is to determine the prevalence of active suicidal thoughts or thoughts of self-harm among hand clinic patients, as indicated by a non-zero response to question nine on the Patient Health Questionnaire-9 (PHQ-9), and to identify potential risk factors associated with an increased likelihood of such thoughts in this patient population.
METHODS: We reviewed one year of patient intake data from our hand center between August 2022 and August 2023. We included all patients who completed at least one depression questionnaire - starting with the PHQ-2 screener and then moving to full PHQ-9 if scoring ≥3 on PHQ-2. Our primary analysis focused on patients who provided a non-zero response to question 9 on the PHQ-9. To investigate potential associations, we performed an independent t-test to assess age and area deprivation index (ADI) differences between two groups: patients with a non-zero response to question 9 and those with a zero response. We used Chi-square tests to determine the difference in question 9 response for sex and race. Lastly, we utilized a logistic regression model to examine the impact of age, sex, race, and ADI on the likelihood of a non-zero response to question 9.
RESULTS: Of 7,023 hand clinic patients, 495 scored ≥3 on the PHQ-2 and underwent the PHQ-9 assessment. Among this subset, 123 patients (25%) (123/495) reported a non-zero response to question 9. Approximately 1.8% (123/7,023) exhibited having active suicidal thoughts or thoughts of self-harm at the time of their hand surgery clinic visit. Age was significantly associated with answering a non-zero response to question 9, with younger adults (mean age=46) more likely to express active thoughts of suicide or self-harm than their older counterparts (mean age=49) (p=0.03). Sex, race, and ADI showed no significant associations with a non-zero response to question 9.
CONCLUSION: About 1 in 57 hand clinic patients reported active suicidal thoughts or thoughts of self-harm, with a higher odds among younger adults; however, the age difference is relatively small and of unclear clinical significance. Overall, the notable incidence of active suicidality or self-harm thoughts in patients presenting for a routine hand surgery clinic visit emphasize the significance of addressing mental health concerns, particularly in these demographic groups, and the need for physicians to be aware of the prevalence of immediate suicidal tendencies among their patients.
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