Statistical and unsupervised learning analysis for the early detection of suicidal ideation in adolescents via the PHQ-9 scale

Statistical and unsupervised learning analysis for the early detection of suicidal ideation in adolescents via the PHQ-9 scale | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Statistical and unsupervised learning analysis for the early detection of suicidal ideation in adolescents via the PHQ-9 scale Michell Guevara Gaviria, Juliana Arias Ramirez, Jose William Martinez, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9294822/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: The prevalence of suicidal behavior in children and adolescents is a critical public health issue, with rates in the coffee region exceeding the national average. This study analyzed responses to the Patient Health Questionnaire (PHQ-9) in a sample of schoolchildren in Pereira, with the aim of enhance risk stratification accuracy tools vía statistic and multivariate techniques. Methods: The magnitude of the effect of depressive symptoms on suicidal ideation was estimated via the nonparametric Cliff's delta statistic, and a hierarchical clustering algorithm (Ward's method) was implemented to detect latent patterns. Results: The results indicated that Item 2 (depressed mood) and Item 6 (negative self-perception) had the greatest discriminatory power, with correlations of \((r=0.62)\) and \((r=0.58)\), respectively, regarding whether the person directly expresses thoughts of death, surpassing those of the other somatic markers. Cluster analysis allowed us to isolate a high-risk profile without previous labels. Conclusions: Results highlight items 2 (feeling down) and 6 (feeling bad about oneself) as having greater discriminatory power for identifying subjects at higher suicidal ideation risk. Clinically, these complaints are often prominent in children and adolescents, who tend to verbalize low self-esteem or loss of motivation rather than sadness, consistent with DSM diagnostic criteria for depression. Suicidal Ideation Patient Health Questionnaire Adolescent Machine Learning Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 11 May, 2026 Reviews received at journal 02 May, 2026 Reviewers agreed at journal 27 Apr, 2026 Reviewers agreed at journal 26 Apr, 2026 Reviewers agreed at journal 20 Apr, 2026 Reviewers invited by journal 15 Apr, 2026 Editor invited by journal 10 Apr, 2026 Editor assigned by journal 08 Apr, 2026 Submission checks completed at journal 08 Apr, 2026 First submitted to journal 01 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9294822","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":627891836,"identity":"5f315bf2-1e55-4b8b-9a9b-bacf2836d5a6","order_by":0,"name":"Michell Guevara Gaviria","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAUlEQVRIiWNgGAWjYDACZgY2BoYCCzhfDkKxEdJiIAHnG0NU49PCgKYlsYGQFt125mcPPgC1yEckH5P4uccufcP93gMMH8oOM/C3N2DVYnaYzdxwBlCL4Y20NMmeZ8m5G47xJTDOOHeYQeLMARxaeNikeUBaZuQYG/AcYAZq4TFg5m07DHRtAm4tf8Ba8j8b/jlQn24A0vKXkBaQ9+Ulchgf8xw4nADWwohXC5uZZI+BBI8BzzPDxzIHjhvOPJaXcLDnXDoPTr+cP/xM4keFjZx8e/KDg28OVMvzHT578MGPMms5XCEGAzwGCCN5GA6ASUJAHmEkYcWjYBSMglEwsgAAigdW9ZssttgAAAAASUVORK5CYII=","orcid":"","institution":"Universidad Tecnologica de Pereira","correspondingAuthor":true,"prefix":"","firstName":"Michell","middleName":"Guevara","lastName":"Gaviria","suffix":""},{"id":627891837,"identity":"93c149c0-3f72-489e-afd0-e08d0ea109b1","order_by":1,"name":"Juliana Arias Ramirez","email":"","orcid":"","institution":"Universidad Tecnologica de Pereira","correspondingAuthor":false,"prefix":"","firstName":"Juliana","middleName":"Arias","lastName":"Ramirez","suffix":""},{"id":627891838,"identity":"6644bc93-66be-4a9b-8492-5fb9ba8d23d0","order_by":2,"name":"Jose William Martinez","email":"","orcid":"","institution":"Universidad Tecnologica de Pereira","correspondingAuthor":false,"prefix":"","firstName":"Jose","middleName":"William","lastName":"Martinez","suffix":""},{"id":627891839,"identity":"9c534c39-932f-4bac-b09b-c753c5760721","order_by":3,"name":"Julian David Echeverry","email":"","orcid":"","institution":"Universidad Tecnologica de Pereira","correspondingAuthor":false,"prefix":"","firstName":"Julian","middleName":"David","lastName":"Echeverry","suffix":""},{"id":627891840,"identity":"ac2cb240-1c7c-4b36-bada-6bf22817c8b1","order_by":4,"name":"Paula Marcela Herrera","email":"","orcid":"","institution":"Universidad Tecnologica de Pereira","correspondingAuthor":false,"prefix":"","firstName":"Paula","middleName":"Marcela","lastName":"Herrera","suffix":""}],"badges":[],"createdAt":"2026-04-01 17:24:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9294822/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9294822/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107705585,"identity":"f66c0da9-4703-4f02-b764-ce1f7b95e9ee","added_by":"auto","created_at":"2026-04-24 09:13:40","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":480326,"visible":true,"origin":"","legend":"","description":"","filename":"ArticleBMCrev.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9294822/v1_covered_fe2dc916-d1cd-4c34-9f3e-ad8e47d1e2f0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Statistical and unsupervised learning analysis for the early detection of suicidal ideation in adolescents via the PHQ-9 scale","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Suicidal Ideation, Patient Health Questionnaire, Adolescent, Machine Learning","lastPublishedDoi":"10.21203/rs.3.rs-9294822/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9294822/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe prevalence of suicidal behavior in children and adolescents is a critical public health issue, with rates in the coffee region exceeding the national average. This study analyzed responses to the Patient Health Questionnaire (PHQ-9) in a sample of schoolchildren in Pereira, with the aim of enhance risk stratification accuracy tools vía statistic and multivariate techniques.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThe magnitude of the effect of depressive symptoms on suicidal ideation was estimated via the nonparametric Cliff's delta statistic, and a hierarchical clustering algorithm (Ward's method) was implemented to detect latent patterns.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe results indicated that Item 2 (depressed mood) and Item 6 (negative self-perception) had the greatest discriminatory power, with correlations of \\((r=0.62)\\) and \\((r=0.58)\\), respectively, regarding whether the person directly expresses thoughts of death, surpassing those of the other somatic markers. 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Clinically, these complaints are often prominent in children and adolescents, who tend to verbalize low self-esteem or loss of motivation rather than sadness, consistent with DSM diagnostic criteria for depression.\u003c/p\u003e","manuscriptTitle":"Statistical and unsupervised learning analysis for the early detection of suicidal ideation in adolescents via the PHQ-9 scale","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-23 05:12:03","doi":"10.21203/rs.3.rs-9294822/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-11T15:00:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-02T18:39:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"307859193251170213262869057313562867418","date":"2026-04-27T09:28:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"41606241783940883989250523656739325674","date":"2026-04-26T19:23:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"90860608443991763830198595181514488778","date":"2026-04-20T17:00:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-15T15:41:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-10T09:27:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-09T02:52:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-09T02:51:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-04-01T17:07:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b432a574-1d1a-4187-a19a-0b37d1fb9e90","owner":[],"postedDate":"April 23rd, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-11T15:00:01+00:00","index":61,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-02T18:39:33+00:00","index":60,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-23T05:12:03+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-23 05:12:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9294822","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9294822","identity":"rs-9294822","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}