Associations of the Patient Safety Screener-3 With Depression and Suicide Risk: A Nationwide Cross-Sectional Study in Japan
- 1Juntendo University Graduate School of Medicine
Abstract
AimThe Patient Safety Screener-3 (PSS-3) is a brief suicide-risk screening tool. Item 1 of this scale assesses depressive mood but is not included in the total score. We examined the association of item 1 with depressive symptom severity and characterized the suicide-related risk captured by PSS-3 total positivity.
MethodsWe conducted a nationwide cross-sectional survey among resident physicians in Japan. Associations between PSS-3 item 1 endorsement and Patient Health Questionnaire-9 (PHQ-9) scores were evaluated using the Wilcoxon rank-sum test. Diagnostic performance of item 1 was evaluated using PHQ-9 positivity ([≥]10) as reference standard. We also compared Short-form Scale for Suicide Ideation (SIS-6) scores according to PSS-3 total positivity and PHQ-9 item 9 positivity.
ResultsA total of 1,844 participants were included. PSS-3 item 1 was endorsed by 443 physicians (24.0%), and 47 (2.5%) met the criteria for PSS-3 total positivity. Item 1 showed 79.3% sensitivity and 79.5% specificity for PHQ-9 positivity. SIS-6 scores were higher in the PSS-3 total-positive group than in the total-negative group (median [IQR], 6 [5-9] vs 0 [0-1]; p<0.001). The SIS-6 showed a higher area under the receiver operating characteristic curve (AUC) and Youden index using PSS-3 total positivity (AUC, 0.961; optimal cutoff, 3) than PHQ-9 item 9 positivity (AUC, 0.907; optimal cutoff, 2).
DiscussionPSS-3 may support brief, simultaneous screening for depressive symptoms and suicide- related risk. Compared with PHQ-9 item 9, PSS-3 may capture a more severe spectrum of suicide- related risk. PSS-3 may facilitate identification of individuals requiring further mental health assessment.
Graphical Abstract
O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=109 SRC="FIGDIR/small/26361711v1_ufig1.gif" ALT="Figure 1"> View larger version (30K): [email protected]@5c1eaeorg.highwire.dtl.DTLVardef@1e26602org.highwire.dtl.DTLVardef@9722c9_HPS_FORMAT_FIGEXP M_FIG C_FIG
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BibTeX
@misc{kiryu2026associations,
title = {{Associations of the Patient Safety Screener-3 With Depression and Suicide Risk: A Nationwide Cross-Sectional Study in Japan}},
author = {K. Kiryu and H. Tamune and K. Takahashi and H. Fujikawa and H. Harada and S. Fukui and K. Nagasaki and Y. Nishizaki and T. Kato and Y. Tokuda},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.30.26361711},
url = {https://www.medrxiv.org/content/10.64898/2026.08.30.26361711v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Associations of the Patient Safety Screener-3 With Depression and Suicide Risk: A Nationwide Cross-Sectional Study in Japan
AU - K. Kiryu
AU - H. Tamune
AU - K. Takahashi
AU - H. Fujikawa
AU - H. Harada
AU - S. Fukui
AU - K. Nagasaki
AU - Y. Nishizaki
AU - T. Kato
AU - Y. Tokuda
PY - 2026
DA - 2026/08/30
PB - medRxiv
DO - 10.64898/2026.08.30.26361711
UR - https://www.medrxiv.org/content/10.64898/2026.08.30.26361711v1
AB - AimThe Patient Safety Screener-3 (PSS-3) is a brief suicide-risk screening tool. Item 1 of this scale assesses depressive mood but is not included in the total score. We examined the association of item 1 with depressive symptom severity and characterized the suicide-related risk captured by PSS-3 total positivity. MethodsWe conducted a nationwide cross-sectional survey among resident physicians in Japan. Associations between PSS-3 item 1 endorsement and Patient Health Questionnaire-9 (PHQ-9) scores were evaluated using the Wilcoxon rank-sum test. Diagnostic performance of item 1 was evaluated using PHQ-9 positivity ([≥]10) as reference standard. We also compared Short-form Scale for Suicide Ideation (SIS-6) scores according to PSS-3 total positivity and PHQ-9 item 9 positivity. ResultsA total of 1,844 participants were included. PSS-3 item 1 was endorsed by 443 physicians (24.0%), and 47 (2.5%) met the criteria for PSS-3 total positivity. Item 1 showed 79.3% sensitivity and 79.5% specificity for PHQ-9 positivity. SIS-6 scores were higher in the PSS-3 total-positive group than in the total-negative group (median [IQR], 6 [5-9] vs 0 [0-1]; p<0.001). The SIS-6 showed a higher area under the receiver operating characteristic curve (AUC) and Youden index using PSS-3 total positivity (AUC, 0.961; optimal cutoff, 3) than PHQ-9 item 9 positivity (AUC, 0.907; optimal cutoff, 2). DiscussionPSS-3 may support brief, simultaneous screening for depressive symptoms and suicide- related risk. Compared with PHQ-9 item 9, PSS-3 may capture a more severe spectrum of suicide- related risk. PSS-3 may facilitate identification of individuals requiring further mental health assessment. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=109 SRC="FIGDIR/small/26361711v1_ufig1.gif" ALT="Figure 1"> View larger version (30K): [email protected]@5c1eaeorg.highwire.dtl.DTLVardef@1e26602org.highwire.dtl.DTLVardef@9722c9_HPS_FORMAT_FIGEXP M_FIG C_FIG
ER -