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During a routine primary care visit, a 45-year-old male with no psychiatric history completes the PHQ-9 as part of standard depression screening. He scores a total of 7 and endorses question 9, 'Thoughts that you would be better off dead, or of hurting yourself', as occurring 'several days' over the past 2 weeks. The PMHNP's most appropriate next step is:
Explanation
The PHQ-9 is a depression screening tool, but item 9 functions as a built-in safety screen. Any positive response to item 9, even 'several days'. This requires an immediate, thorough suicide risk assessment independent of the total score. This is a patient safety standard, not a clinical judgment call.
Key Takeaway
Any endorsement of PHQ-9 question 9 (suicidal ideation) requires immediate suicide risk assessment, regardless of the total PHQ-9 score.