Predictive Value of the Huaxi Emotional Index in Assessing and Identifying High Suicide Risk Among Inpatients With Depression

Objective This study aims to investigate the agreement between the Huaxi Emotional Index (HEI) and the Nurses’ Global Assessment of Suicide Risk (NGASR) in assessing high suicide risk and to explore the predictive value of HEI in identifying high suicide risk among patients with depression.

Methods  Convenience sampling was used and 386 inpatients with depression were included in this cross-sectional study. All patients were admitted to the Mental Health Center, West China Hospital between June and December 2023. The inclusion criteria were as follows, a diagnosis of depression according to the International Classification of Diseases, Tenth Revision (ICD-10), age over 18, and completion of both NGASR and HEI assessments. According to the exclusion criteria, depression patients who had other comorbid mental disorders or those who had severe cognitive impairments and were unable to communicate effectively were excluded. The study was approved by the Biomedical Ethics Review Committee of West China Hospital (Approval No. 647, 2021). Demographic data such as age, sex, ethnicity, marital status, and educational attainment were collected using a self-designed questionnaire. Both the HEI and NGASR were applied to evaluate the patients. We conducted statistical analyses with SPSS 27, employing Spearman’s rank correlation for correlation analysis, Kappa tests for consistency between the two instruments, and receiver operating characteristic (ROC) curves for evaluating the predictive performance of HEI scores for high suicide risk, with the optimal HEI cutoff value determined on the basis of the Youden Index.

Results The study included 386 depression inpatients with an average age of 32 years and an average length-of-stay of 14 days. Of these participants, 252 were female (65.3%) and 134 were male (34.7%). Regarding ethnicity, most of the participants were Han Chinese (89.4%), Tibetans accounted for 7.3%, and other minorities, 3.3%. Regarding marital status, 51.3% of the participants were married, 41.2% single, 6.5% divorced, and 1.0% widowed. Regarding educational attainment, 26.2% had an undergraduate or graduate education, 20.7% had junior college education, 24.8% had high school or secondary technical school education, and 28.2% had middle school education or less. The NGASR identified 57.3% of the participants as being at high suicide risk, while the HEI identified 53.6% as having severe emotional distress. There was a moderate agreement between the HEI and the NGASR scores, with a Kappa value of 0.518 (P<0.001), indicating statistically significant differences. At an HEI score of 17, the Youden Index peaked at 0.52, predicting high suicide risk with a specificity of 76.36%, a sensitivity of 76.02%, and an area under the ROC curve of 0.829 (95% CI: 0.787-0.871), demonstrating statistically significant differences.

Conclusion HEI and NGASR demonstrate moderate agreement in assessing high suicide risk among depression patients. The HEI questionnaire effectively predicts high suicide risk in patients with depression, with 17 being the optimal cutoff value for assessing high suicide risk.