Though the primary care setting presents an excellent venue for detection of and early intervention for suicide risk – up to 75 percent of people who commit suicide have seen a primary care clinician in the previous 30 days – this study finds that primary care physicians do not consistently inquire about suicidality.
In a study of 152 physicians, suicide was explored in only 36 percent of 298 encounters with patient actors who portrayed depressive symptoms. Notably, exploration was more common when the patient portrayed major depression (versus adjustment disorder) and when they made a request for antidepressant medication.
The latter finding was especially true when general (as opposed to brand name) antidepressant medication requests were made. Exploration was also more common in academic settings and among physicians who have had a personal experience with depression (whether in themselves, family members or close friends).
The authors conclude that their findings suggest that one approach to improving the rate of physician recognition of suicidal thinking in depressed patients is through advertising or public service messaging that prompts patients to ask for help to treat depression without encouraging them to request specific antidepressant medications.
Let’s Not Talk About It: Suicide Inquiry in Primary Care
By Peter Franks, M.D., et al