Risk Assessment and Suicide Prevention in Primary Care

Abstract

General practitioners (GPs) are assumed to occupy an important position in the prevention of suicide through the introduction of risk assessment techniques commonly used in psychiatric practice. Despite this theoretical role for primary care services, it remains unclear how frequently GPs implement risk assessment in patients who may be vulnerable to suicide. To address this, a retrospective survey of probable suicides was conducted within a primary care setting utilizing a questionnaire of GPs who had experienced a patient suicide and was augmented by hospital and coroners' records. 85% of questionnaires were returned and 61 deaths were adjudged as suicides during the year long census period. 75% of suicides were male and 54% were aged under 35.28% were in contact with psychiatric services prior to death, although 60% had some diagnosis of mental disorder. GPs had little knowledge of a patient's life circumstances in up to half of cases. Recording of risk assessment occurred in 38% of subjects, was positively associated with prior psychiatric contact (p = 0.001) but negatively associated with presence of physical illness (p = 0.004), older patient age (p = 0.04), and GPs length in practice (p = 0.05). One GP felt their suicide case was preventable. The low rate of risk assessment and limited knowledge of patient lifestyle point to the need for active engagement of GPs in future suicide prevention strategies and should influence the content of training programs in primary care.

A qualitative study on primary health care professionals’ perceptions of mental health, suicidal problems and help-seeking among young people in Nicaragua

“…Milton and co-authors showed that only one out of 52 general practitioners considered suicide to be preventable [13]. Our study also shows constricted thinking to be common.…”

“…Doctors in rural hospitals felt that relations with other staff members functioned as a barrier to the appropriate management of suicidal patients [12]. Misconceptions might also be a barrier; a study in primary health care found that only one out of 52 general practitioners believed that suicide was preventable [13]. …”

Suicide Victims’ Last Contact With the Primary Care Physician: Report From Slovenia

“…As for the reason of the visit, studies have reported that in the group of suicide victims, the reason for the last appointment with the primary physician was a mental disorder but not so in the control group (Murphy, 1975;Power et al, 1997;Matthews et al, 1994;Milton et al, 1999). The results of our study confi rm and support these fi ndings.…”

“…Furthermore, in more than 50% of cases the primary care physicians did not know anything about the life circumstances of their patients. The suicide risk was recognized in only 38% of cases, which was positively related to the presence of a psychiatric diagnosis and negatively with the diagnosis of physical illness (Milton et al, 1999).…”

Recognition of Suicide Risk According to the Characteristics of the Suicide Process

“…Other studies support this finding that the warning signs of suicide may be overlooked in the primary care setting (Beautrais, Joyce, & Mulder, 1998;Pirkis & Burgess, 1998). Milton, Ferguson, and Mills (1999) suggested that limited knowledge of a patient's life circumstances may contribute to the physician's inability to detect risk in up to half of all cases. For those patients who do not have a psychiatric history and whose consultation patterns do not differ from the norm, it may be difficult to suggest improvements in the recognition of risk (Power, Davies, Swanson, Gordon, & Carter, 1997).…”