Educational interventions for general practitioners to identify and manage depression as a suicide risk factor in young people: a systematic review and meta-analysis protocol

Abstract

BackgroundSuicide is a major public health problem and globally is the second leading cause of death in young adults. Globally, there are 164,000 suicides per year in young people under 25 years. Depression is a strong risk factor for suicide. Evidence shows that 45% of those completing suicide, including young adults, contact their general practitioner rather than a mental health professional in the month before their death. Further evidence indicates that risk factors or early warning signs of suicide in young people go undetected and untreated by general practitioners. Healthcare-based suicide prevention interventions targeted at general practitioners are designed to increase identification of at-risk young people. The rationale of this type of intervention is that early identification and improved clinical management of at-risk individuals will reduce morbidity and mortality. This systematic review will synthesise evidence on the effectiveness of education interventions for general practitioners in identifying and managing depression as a suicide risk factor in young people.Methods/designWe shall conduct a systematic review and meta-analysis following the Cochrane Handbook for Systematic Reviews of Interventions guidelines and conform to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. Electronic databases will be systematically searched for randomised controlled trials and quasi-experimental studies investigating the effectiveness of interventions for general practitioners in identifying and managing depression as a suicide risk factor in young people in comparison to any other intervention, no intervention, usual care or waiting list. Grey literature will be searched by screening trial registers. Only studies published in English will be included. No date restrictions will be applied. Two authors will independently screen titles and abstracts of potential studies. The primary outcome is identification and management of depression. Secondary outcomes are suicidal ideation, suicide attempts, deliberate self-harm, knowledge of suicide risk factors and suicide-related behaviours, attitudes towards suicide risk and suicide-related behaviours, confidence in dealing with suicide risk factors and suicide-related behaviour.DiscussionOur study will inform the development of future education interventions and provide feasibility and acceptability evidence, to help general practitioners identify and manage suicidal behaviour in young people.Systematic review registrationPROSPERO registration number: CRD42014009110.Electronic supplementary materialThe online version of this article (doi:10.1186/2046-4053-3-145) contains supplementary material, which is available to authorized users.

Psychometric evaluation of the Questionnaire on Attitudes Towards Suicide (ATTS) in Poland

“…The existence of relatively high suicide rates within the Polish community (World Health Organization 2017) calls attention to the attitudes towards suicide and suicide prevention borne by both the gatekeepers and the general population; these have considerable significance in vulnerability to suicide, help-seeking behavior and healthcare providers' reactions towards people at suicide risk (Horowitz et al 2012;Stevens and Nies 2018;Tait and Michail 2014). The revised ATTS can help in monitoring suicide attitudes; however, to improve attitudes towards suicide prevention, suicide management should involve providing gatekeepers with prevention techniques and enhancing their capacity to care (Stevens and Nies 2018).…”

“…Growing interest in understanding suicide prevention (Sallander Renberg 2001;Sallander Renberg and Jacobsson 2003) resulted in the introduction of new suicide screening questionnaires. This growth is believed to improve attitudes towards prevention by increasing the likelihood of asking about suicide and consequently breaking the taboo driven by fearful attitudes (Horowitz et al 2012;Tait and Michail 2014). Fear triggers different potentially negative ways of helping Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12144-019-00185-1) contains supplementary material, which is available to authorized users.…”

Italian patients with more recent onset of Major Depressive Disorder have a shorter duration of untreated illness

“…9,10 This result supports the notion that patients suffering from MDD may expect many years, on average, from the beginning of their illness before receiving an adequate treatment. In relation to pharmacological treatment, it is worth noting that benzodiazepine prescription was found to be decreased in patients [39][40][41] Nevertheless, the GP's diagnostic accuracy for psychiatric conditions might need additional empowerment. 41 In fact, educational methods have shown to be effective in improving diagnostic competency of GPs for psychiatric disorders.…”

“…This result highlights the importance of the GP in identifying and managing patients suffering from MDD, particularly with mild forms of illness [39][40][41]. Such a scenario may reflect the lower use of symptomatic compounds (benzodiazepines) and a more appropriate and guideline-oriented prescription of antidepressant compounds.…”

Suicide by Homemade Hydrogen Sulfide in Turkey a Case Report

“…Suicide rates for 15-24 years group are estimated as 20/100,000 for males and 4.9/100,000 for females (2). Studies focusing on how mental health risk factors impact on youth suicidal behaviors suggest that psychopathological symptoms are associated with suicidal behavior (3,4).…”