Independent association of depressed mood and high suicide risk as assessed by the patient safety screener-3 (PSS-3) with prolonged hospitalization: A single-center cross-sectional study

Abstract

Purpose

We developed a Japanese version of the Patient Safety Screener-3 (PSS-3) and applied it to stratify suicide risk in hospitalized patients. Additionally, we tested the hypothesis that PSS-3-assessed depressed mood and suicide risk are independently associated with length of stay (LOS) among hospitalized patients.

Methods

A cross-sectional study was conducted at a university hospital in Tokyo from January to December 2023. The Japanese version of the PSS-3 was used to screen hospitalized patients with advanced cancer. Data were collected from medical charts and Diagnosis Procedure Combination records. Linear mixed-effects models with patient-level random intercepts were used to examine associations among depressed mood, suicide risk, and LOS, adjusting for age, sex, cancer diagnosis, Charlson Comorbidity Index, activities of daily living (ADL), and disturbance of consciousness.

Results

Among 2077 screenings, 2019 first assessments on admission were analyzed, of which 90.8 % were performed on admission day. Depressed mood was present in 308 patients (15.3 %), and 26 patients (1.3 %) were assessed as having high suicide risk. Depressed mood prolonged LOS (reference geometric mean: 8.44 days) by 18 % (1.18; 95 % CI, 1.07–1.30), while high suicide risk prolonged it by 40 % (1.40; 95 % CI, 1.03–1.90), in a clinically and statistically balanced model adjusted for age, sex, and cancer diagnosis.

Conclusions

The PSS-3 stratified hospitalized patients by depressed mood and suicide risk, both of which were independently associated with prolonged hospitalization. This simple screening tool may facilitate early identification of high-risk patients, optimize resource allocation, and improve patient care.