Training general practitioners to recognise and respond to psychological distress and suicidal ideation in young people

Abstract

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.

Physicians' Characteristics Associated with Exploring Suicide Risk among Patients with Depression: A French Panel Survey of General Practitioners

“…These results are strikingly different from those we have found related to other aspects of depression management, such as prescriptions of antidepressants or referral for psychotherapy: the latter were strongly associated with GPs' personal characteristics and attitudes, but independent of CME or network participation [31], [32]. As the literature indicates, CME appears to have a positive impact on asking depressed patients about suicidal thoughts [42]–[44]. Trained GPs may conduct in-depth explorations of suicide risk more frequently, partly because they are less reluctant to question patients about suicide and have more skill and expertise in such questioning.…”

Managing child and adolescent mental health problems in primary care: taking the leap from knowledge to practice

“…Furthermore, young people commonly present with recurrent unexplained functional physical symptoms, a somatised expression of stress often accompanied by psychiatric disorder. Studies in the United States and Australia show that many young people have contact with primary care in the month before suicide or self-harm (Pfaff et al, 2001;Luoma et al, 2002); however, fewer than half of primary care physicians report screening their adolescent patients for suicide risk (Frankenfield et al, 2000). Nevertheless, rates of recognition of psychiatric disorder in young people attending primary care are poor (Garralda and Bailey, 1986;Chang et al, 1988;Kramer and Garralda, 1998;Sayal and Taylor, 2004).…”

Suicidality in pre-adolescence and early adulthood is associated with psychosocial and psychiatric problems in young adulthood

“…These have included family oriented therapies, problem solving training, cognitive behavioural therapy (CBT), dialectical behavioural therapy, pharmacotherapy, and training general practitioners to better recognise and treat suicidality in young people. [7][8][9][10][11][12] However, most of these have not been rigorously evaluated. One exception is the TADS study, a randomised controlled trial (RCT) of 439 adolescents (12-17 years) assigned to one of three treatments: 12 weeks of fluoxetine (10-40 mg/day) or CBT or CBT with fluoxetine.…”