Suicide in primary care: How to screen and intervene

Dixon, Mark A; Hyer, Steven M; Snowden, David L.

doi:10.1177/00912174211042435

Cited by 4 publications

(3 citation statements)

References 19 publications

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“…However, while professionals agreed that the first aider should be aware that directly asking about suicide does not increase the risk (and can provide an opportunity for exploring other solutions), and that they should inquire about such thoughts and plans, lived experience experts only endorsed the awareness aspect but did not fully support the act of asking. This apparent inconsistency could be interpreted as a manifestation of concern or insecurity on the part of the lived experience experts, perceiving that they might ask inappropriate questions and generate undesirable effects, such as a sense of mistrust from the person, which could create barriers to disclosing suicidal thoughts [ 90 , 91 ].…”

Section: Discussionmentioning

confidence: 99%

Development of mental health first-aid guidelines for suicide risk: a Delphi expert consensus study in Argentina and Chile

Encina-Zúñiga,

Rodante,

Agrest

et al. 2023

BMC Psychiatry

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Background Suicide continues to pose a significant global public health challenge and ranks as one of the leading causes of death worldwide. Given the prevalence of suicide risk in the community, there is a significant likelihood of encountering individuals who may be experiencing suicidal thoughts or plans, creating an opening for non-health professionals to offer support. This study aims to culturally adapt the original Australian Mental Health First Aid Guidelines for suicide risk to the Chilean and Argentine context. Methods A two-round Delphi expert consensus study was conducted involving two panels, one comprising individuals with personal experience in suicide thoughts/attempts or caregiving for those with such experiences (n = 18), and the other consisting of professionals specialized in suicide assessment and support for individuals at risk (n = 25). They rated a total of 179 items mainly derived from guidelines developed by Australian experts and translated into Spanish (168), and new items included by the research team (11). The panel members were requested to assess each item utilizing a five-point Likert scale. During the second round, items that received moderate approval in the initial round were re-evaluated, and new items suggested by the local experts in the first round were also subjected to evaluation in the next round. Inclusion in the final guidelines required an 80% endorsement as “essential” or “important” from both panels. Results Consensus of approval was reached for 189 statements. Among these, 139 statements were derived from the English-language guidelines, while 50 locally generated statements were accepted during the second round. A significant difference from the original guideline was identified concerning the local experts’ reluctance to discuss actions collaboratively with adolescents. Furthermore, the local experts proposed the inclusion of an entirely new section addressing suicide risk in older individuals, particularly focusing on suicide methods and warning signs. Conclusions A Delphi expert consensus study was conducted to culturally adapt mental health first aid guidelines for assessing suicide risk in Chile and Argentina. This study involved professionals and individuals with lived experience. While many items were endorsed, some related to inquiring about suicide risk and autonomy, particularly for adolescents, were not. An additional section for older individuals was introduced. Future research should explore the implementation and impact of these adapted guidelines in training courses. This is vital for enhancing mental health support and implementing effective suicide prevention strategies in Chile and Argentina.

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Section: Discussionmentioning

confidence: 99%

Development of mental health first-aid guidelines for suicide risk: a Delphi expert consensus study in Argentina and Chile

Encina-Zúñiga,

Rodante,

Agrest

et al. 2023

BMC Psychiatry

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“…One model of assessment for primary care suggests physicians work through five steps during the interaction with their patients at risk of suicide: (1) recognize distress, (2) inquire about risk and plans, (3) assess risk and mitigations factors, (4) develop a management plan, and (5) document the plan and rationale behind it. 24 Both of these models are supported and enhanced through the utilization of SDT and MI during the risk assessment.…”

Section: Sdt As the Framework MI As The Tool In Suicide Assessmentmentioning

confidence: 99%

Motivational Interviewing and Self-Determination Theory in Suicide Assessment: A Practical Application to Aid Residents’ Management of Suicide

Hyer

Dixon²

2022

Int J Psychiatry Med

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Suicide is a problem on the rise in the United States. One significant avenue to help reverse the trend is through family medicine and interventions within primary care clinics. This can be a significant stressor for many family medicine physicians to manage patients experiencing suicidal ideation within their busy schedule. Motivational Interviewing is an evidence-based method of interacting with patients in a healthy and collaborative manner. The literature is growing on how to use Motivational Interviewing in assessments of suicidal ideation. Additionally, Self-Determination Theory proposes that individuals have three basic needs: a sense of connection, a level of autonomy, and a degree of competence. These needs and the associated principles of intrinsic and extrinsic motivation help to explain why Motivational Interviewing can be so helpful in the change process. By examining the principles of Motivational Interviewing and Self-Determination Theory residents will be able to better create an environment conducive to collaborative sharing, honest discussion, and meaningful assessment to ensure safety for patients in primary care.

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“…According to the current German national guideline on the treatment of patients with depression [14], SI should be addressed directly and seriously by the GP. In order to assist GPs with this difficult task, it is imperative to provide instruments that can be efficiently integrated into everyday practice, are time-saving, and reliable to rule-out suicidal patients with high certainty [15][16][17]. Screening instruments have already been developed in the English-speaking world [16,18] including the following: P4 [19], Paykel Suicide Items (PSI) [20], Depressive Symptom Inventory Suicidality Subscale (DSI-SS) [21], or Suicide Behaviors Questionnaire-Revised (SBQ-R) [22].…”

Section: Introductionmentioning

confidence: 99%

Validation of the German Version of the P4 Suicidality Tool

Schluessel,

Halfter,

Haas

et al. 2023

JCM

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For general practitioners (GPs), it may be challenging to assess suicidal ideation (SI) in patients. Although promising instruments exist for the use in primary care, only a few have been validated in German. The objectives of this study were to examine the validity of the brief P4 screener for assessing SI in a cross-sectional study including outpatients. Inclusion criteria were a PHQ-9 score ≥ 10 or an affirmative answer to its SI item. Construct validity of the P4 was examined by comparison with the four-item Suicide Behaviors Questionnaire-Revised (SBQ-R), the PHQ-9 (convergent), and the positive mental health (PMH) scale (divergent). The study sample included 223 patients (mean age 47.61 ± 15 years; 61.9% women) from 20 primary care practices (104 patients) and 10 psychiatric/psychotherapeutic clinics (119 patients). The first three items of the P4 correlate positively with most of the four items of the reference standard SBQ-R (convergent validity); the fourth item of the P4 (preventive factors) correlates significantly with the PMH scale. The most common preventive factor (67%) is family or friends. The German P4 screener can be used to assess SI in outpatient care. It explores preventive or protective factors of suicide, which may support the GP’s decision on treatment. We recommend a further clinical interview for patients flagged by P4 assessment in order to more formally assess suicidal risk.

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Suicide in primary care: How to screen and intervene

Cited by 4 publications

References 19 publications

Development of mental health first-aid guidelines for suicide risk: a Delphi expert consensus study in Argentina and Chile

Development of mental health first-aid guidelines for suicide risk: a Delphi expert consensus study in Argentina and Chile

Motivational Interviewing and Self-Determination Theory in Suicide Assessment: A Practical Application to Aid Residents’ Management of Suicide

Validation of the German Version of the P4 Suicidality Tool

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