Objective
To determine the effectiveness of a training program for general practitioners in recognising and responding to psychological distress and suicidal ideation in young people.
Design and setting
The study, conducted in general practice surgeries in Tasmania, Victoria and Western Australia in 1996 and 1997, used a pre‐/post‐test design to audit consecutive young patients presenting in the six weeks before and the six weeks after the GPs' participation in the training program.
Participants
Consisted of 23 GPs who attended a youth suicide prevention workshop and 423 patients aged 15–24 years who presented to the GPs' surgeries (203 pre‐workshop and 220 post‐workshop).
Intervention
GPs attended a one‐day training workshop designed to enhance their ability to recognise, assess and manage young patients at risk of suicide.
Main outcome measures
Scores on three patient self report inventories (General Health Questionnaire‐12 [GHQ‐12], Center for Epidemiological Studies Depression Scale [CES‐D] and Depressive Symptom Inventory – Suicidality Subscale [DSI‐SS]); a GP‐completed form for each patient summarising presenting complaint(s), psychological assessment and proposed management plan.
Results
After training, GPs demonstrated increased recognition rates of psychologically distressed patients scoring above the cut‐offs of the GHQ‐12 (48% increase; odds ratio [OR], 1.748; 95% CI, 0.904–03.381) and CES‐D (39.5% increase; OR, 2.067; 95% CI, 1.031–4.143); enquiry about suicidal ideation increased by 32.5% (OR, 1.483; 95% CI, 0.929–2.366); and identification of suicidal patients (determined by DSI‐SS score) increased by 130% (OR, 3.949; 95% CI, 1.577–9.888). Training did not lead to any significant change in GPs' patient management strategies.
Conclusions
A one‐day training course can significantly enhance GP detection rates of psychological distress and suicidal ideation in young patients, but higher recognition rates do not necessarily lead to changes in patient management.
In Australia a police project incorporating four parallel trials was established to test a new model of illicit drug law enforcement, which gives greater emphasis to harm reduction at the community level. The project was based on a community-policing model developed in the United Kingdom and involved establishing a community based consultation structure comprising an implementation oriented Drug Action Team (DAT) and support oriented Drug Reference Group (DRG). Two of the trials operated in Western Australia: one in Geraldton, a small regional city; and the other in Mirrabooka, a large, diverse, metropolitan region within Perth. The project officers were faced with a number of challenges and had to develop strategies to overcome these. One of the important issues was the effect of continual changes in membership of DATs, and consequent fluctuating levels of enthusiasm and commitment. The size and composition of the DATs also had an impact on how they operated. Other issues included the management of different agency agendas and recognition that the project would only operate for a limited time. How the project officers dealt with these issues in their development of the DAT/DRG model and how the two trial sites incorporated harm reduction into illicit drug policing are presented and discussed.2
In this pilot study, patients aged 15-24 presenting to five general practices had relatively high levels of psychological distress and suicidal ideation. Of most concern were those presenting with medical complaints and who also had high levels of unreported psychological distress.
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