Family physicians and the risk of suicide in the depressed elderly

Stoppe, Gabriela; Sandholzer, Hagen; Huppertz, Claudia; Duwe, H.; Staedt, J.

doi:10.1016/s0165-0327(98)00149-9

Cited by 55 publications

(38 citation statements)

References 30 publications

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“…Internal medicine 98 (33) 200 (67) 35 (36) 73 (36) 63 (64) 127 (64) . (14) 60 (20) 101 (34) 96 (32) 14 (34) 19 (32) 40 (40) 35 (36) 27 (66) 41 (68) 61 (60) 61 (64) .…”

Section: Family Medicineunclassified

“…Some physicians might avoid bringing up the issue of suicide because of fears that broaching the topic might heighten patients' suicidal feelings. 33 Others could be concerned about offending the patient or are themselves made uncomfortable by the prospect of inquiring about a behavior that was once considered a sin by many religious authorities and a crime in many legal jurisdictions worldwide. Prior work on primary care physicians' response to domestic violence invoked the image of opening Pandora's box to explain why they avoided screening for domestic violence.…”

mentioning

confidence: 99%

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Let's Not Talk About It: Suicide Inquiry in Primary Care

Feldman¹,

Franks²,

Duberstein³

et al. 2007

The Annals of Family Medicine

140

106

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PURPOSE The purpose of this study was to ascertain physician characteristics associated with exploring suicidality in patients with depressive symptoms and the infl uence of patient antidepressant requests.METHODS Primary care physicians were randomly recruited from 4 sites in northern California and Rochester, NY; 152 physicians participated (53%-61% of those approached). Standardized patients portraying 2 conditions (major depression and adjustment disorder) and 3 antidepressant request types (brand specifi c, general, or none) made unannounced visits to these physicians between May 2003 and May 2004. We examined factors associated with physician exploration of suicidality.RESULTS Suicide was explored in 36% of 298 encounters. Exploration was more common when the patient portrayed major depression (vs adjustment disorder) (P = .03), with an antidepressant request (vs no request) (P = .02), in academic settings (P <.01), and among physicians with personal experience with depression (P <.01). The random effects logistic model revealed a signifi cant physician variance component with ρ = 0.57 (95% confi dence interval, 0.45-0.68) indicating that there were additional, unspecifi ed physician factors determining the tendency to explore suicide risk. These factors are unrelated to physician specialty (family medicine or internal medicine), sex, communication style, or perceived barriers to or confi dence in treating depression.CONCLUSIONS When seeing patients with depressive symptoms, primary care physicians do not consistently inquire about suicidality. Their inquiries into suicidal thinking may be enhanced through advertising or public service messaging that prompts patients to ask for help. Research is needed to further elucidate physician characteristics associated with the assessment of suicidality. INTRODUCTIONSuicide is a leading cause of death and potential life-years lost worldwide. 1 Most people who die by suicide have a treatable mental disorder, usually depression, but few have seen a mental health specialist. 2,3 Although many patients are reluctant to seek and actively engage in mental health treatment, up to 75% of those who complete suicide have seen a primary care clinician in the previous 30 days. [4][5][6][7] The primary care setting thus presents an excellent venue for detection of and early intervention for suicide risk. 8,9 Suicide ideation, defi ned as the presence of passive or active thoughts about a premature end of life, is present in 2% to 7% of all primary care patients.10,11 Suicide ideation confers risk for suicide as well as morbidity and all-cause mortality. [12][13][14][15][16][17][18] In spite of ample opportunity for detection and intervention, presuicidal patients seldom alert physicians to their plans, and studies have found low rates of inquiry and detection of patients' suicidal thoughts by primary care practitioners. 8,15,19 Remarkably little is known about the factors that infl uence whether primary care physicians broach the topic of suicide. [20][21][22][23] To d...

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“…Internal medicine 98 (33) 200 (67) 35 (36) 73 (36) 63 (64) 127 (64) . (14) 60 (20) 101 (34) 96 (32) 14 (34) 19 (32) 40 (40) 35 (36) 27 (66) 41 (68) 61 (60) 61 (64) .…”

Section: Family Medicineunclassified

mentioning

confidence: 99%

Let's Not Talk About It: Suicide Inquiry in Primary Care

Feldman¹,

Franks²,

Duberstein³

et al. 2007

The Annals of Family Medicine

140

106

View full text Add to dashboard Cite

show abstract

“…Hence it is sometimes difficult to diagnose depression in the elderly (Yesavage, 1992). When they are recognised as being depressed, they are often managed inadequately with treatment that is inappropriate in nature, duration or dosage, and very few doctors (2.4%) think spontaneously of looking for associated suicidal ideation (Stoppe et al, 1999).…”

Section: Characteristics Of Elderly Suicide Attemptersmentioning

confidence: 99%

Elderly suicide attempters: characteristics and outcome

Lebret¹,

Perret-Vaille²,

Mulliez

et al. 2006

Int J Geriat Psychiatry

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SUMMARYPurpose We made a descriptive survey to assess the outcome of elderly patients discharged from a hospital psychiatric service after a suicide attempt (rates of overall mortality and repeat attempts), to identify the factors that had a significant impact on their survival and to determine patient characteristics. Methods Fifty-nine suicide attempters over 60 years of age admitted to hospital between 1993 and 2000 were included in the study. Their outcome was assessed by questioning their attending physicians over the telephone. We traced 51 of the 59 patients; 8 were lost to follow-up. Statistical analysis (Log Rank tests, Cox model) was computed to determine which factors altered the overall survival and the survival without further attempt.The patients sociodemographic, medical and psychiatric characteristics were recorded from hospital patient files. Results Elderly suicide attempters showed an increased mortality from suicide and natural causes and the risk of a repeat attempt increased in female patients with memory disorders. The factors altering survival were advanced age, pre-existing physical disability, several co-existing physical illnesses, severe physical consequences of the suicide attempt, history of psychiatric illness other than depression, memory disorders and one previous suicide attempt.The elderly suicide attempter was most likely to be a widowed woman suffering from social isolation, loneliness and depression. Conclusion Elderly suicide attempters remained both physically and mentally vulnerable after their attempt. A repeat act represents a turning point in personal life progression which it is essential to detect.

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“…In generating risk-stratifi ed suicide rates, valid and effi cient assessment strategies should be used. The available approaches [7][8][9][10] have been perfected in research protocols and mental health settings, but their validity and applicability to primary care practice are unclear.…”

Section: Depression and Suicidal Ideationmentioning

confidence: 99%

Suicidal Ideation and Risk Levels Among Primary Care Patients With Uncomplicated Depression

Schulberg

Lee²,

Bruce³

et al. 2005

The Annals of Family Medicine

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PURPOSEWe investigated the prevalence, severity, and course of passive and active suicidal ideation occurring in primary care patients with an uncomplicated depressive disorder. METHODSWe studied suicidal ideation experienced by patients recruited in 60 primary care practices participating in a randomized controlled trial of depression management. Risk levels associated with suicidal ideation and plans were determined by a 2-stage procedure using pertinent items of the Patient Health Questionnaire-9, the Hopkins Symptom Checklist-20, and the Cornell structured assessment interview and management algorithm. RESULTSOf the 761 patients whom physicians judged in need of treatment for a clinical depression, 405 (53%) were experiencing uncomplicated dysthymia, major depression, or both. Among these depressed patients, about 90% had no risk or a low risk of self-harm based on the presence and nature of suicidal ideation; the rest had an intermediate risk. Almost all patients who were initially classifi ed at the no or low risk levels remained at these levels during the subsequent 6 months. The incidence of suicidal ideation at a risk level requiring the physician's immediate attention in this no-or low-risk subgroup was 1.1% at 3 months and 2.6% at 6 months.CONCLUSIONS Almost all patients with uncomplicated dysthymia, major depression, or both acknowledging suicidal ideation of the minimal risk type when initially assessed maintained this minimal risk status during the subsequent 6 months. INTRODUCTIONT he identifi cation and prevention of suicidality in primary care is of concern at the national policy-making and clinical practice levels. Policy reports of the US Surgeon General 1 and Institute of Medicine 2 assign primary care physicians a key role in assessing and treating patients at risk for self-harming behaviors. Because on average 45% of persons killing themselves contact their physicians in the month preceding the life-ending act, 3 physicians are thought to be potentially capable of preventing this outcome. Primary care physicians, themselves, acknowledge responsibility for suicide prevention and participate in educational programs to improve case fi nding and treatment skills.4 Physicians initially should focus on patients experiencing depression because this disorder is a major risk factor for self-harm.As 1% to 10% of primary care patients experience life-ending thoughts and intentions, 5 suicide risk assessment and management of suicidality are intrinsic to primary care practice. Effective approaches to these clinical tasks are hampered, however, by knowledge gaps 6 concerning the severity of sui- cidal ideation and behaviors and how to assess them in primary care. More precise knowledge about the prevalence of suicidal ideation and the various risk levels for self-harm is needed to manage patients at serious risk of hurting themselves, including the extent to which they burden primary care practices and specialized psychiatric services. In generating risk-stratifi ed suicide rates, valid and ef...

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Family physicians and the risk of suicide in the depressed elderly

Cited by 55 publications

References 30 publications

Let's Not Talk About It: Suicide Inquiry in Primary Care

Let's Not Talk About It: Suicide Inquiry in Primary Care

Elderly suicide attempters: characteristics and outcome

Suicidal Ideation and Risk Levels Among Primary Care Patients With Uncomplicated Depression

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