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Crowther G, Ninan S. Managing depression in frail older people; too little too late or pathologising loss? Future Healthc J 2023; 10:107-111. [PMID: 37786635 PMCID: PMC10540808 DOI: 10.7861/fhj.2023-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
It is testament to the advances of modern medicine that we have a population with more older people than ever before. While we are increasingly adept at managing their physical comorbidities, we have made relatively little progress in addressing the psychological impact of ageing. In this article we consider the prevalence and complex aetiology of depression in older people who often have to deal with profound loss, while simultaneously managing multiple comorbidities. We consider the challenges of diagnosing depression faced by healthcare professionals including access to resources and training, and what differentiates depression from socially appropriate low mood. Finally, we discuss treatment options and the difficulties that clinicians face when they have only limited resources and skills available, but a desire to help. We consider the role for antidepressants, and when not to prescribe, before addressing the challenges of providing talking therapies and social interventions.
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Affiliation(s)
- George Crowther
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK; consultant geriatrician, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sean Ninan
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK; consultant geriatrician, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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2
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Christensen LeCloux M, Aguinaldo LD, Lanzillo EC, Horowitz LM. Provider opinions of the acceptability of Ask Suicide-Screening Questions (ASQ) Tool and the ASQ Brief Suicide Safety Assessment (BSSA) for universal suicide risk screening in community healthcare: Potential barriers and necessary elements for future implementation. J Behav Health Serv Res 2022; 49:346-363. [PMID: 35266079 DOI: 10.1007/s11414-022-09787-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 10/18/2022]
Abstract
A convenience sample of community health care providers (N = 19) was asked to preview and rate the acceptability of the Ask Suicide-Screening Questions (ASQ) tool and the ASQ Brief Suicide Safety Assessment (BSSA) guide. Providers were also asked about potential barriers to implementation. The majority of participants stated they would be comfortable screening for suicide with the ASQ tool (78.9%; N = 15), that they would recommend the ASQ tool and the BSSA to colleagues (84.2%; N = 16), and that they were "satisfied" or "highly satisfied" with the ASQ and BSSA (88.2%; N = 13). Barriers to implementation reported included a lack of knowledge regarding suicide risk screening and lack of access to behavioral health resources. Education regarding the ASQ, the BSSA, and suicide risk screening are highlighted as crucial elements for future implementation.
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Affiliation(s)
| | | | | | - Lisa M Horowitz
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Podlipski PL, Tran E, Chrusciel J, Kaladjian A, Sanchez S. [Management of suicidal crisis in general practice: evaluation of care practices according to patient age]. Soins Psychiatr 2022; 43:42-48. [PMID: 35598914 DOI: 10.1016/j.spsy.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Nearly 800,000 people die by suicide each year worldwide. Up to 75% of suicidal patients consulted their general practitioner in the months preceding their attempt. A study, conducted among 167 practitioners in Champagne-Ardenne in 2016-2017, aims to evaluate the practices of general practitioners in the management of suicidal crisis, particularly according to the age of the patient. It provides elements for reflection on their role in suicide prevention.
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Affiliation(s)
- Pierre-Luc Podlipski
- Pôle de psychiatrie des adultes, centre hospitalier universitaire de Reims, faculté de médecine de Reims, rue du Général-Koenig, 51100 Reims, France
| | - Eric Tran
- Pôle territorial santé publique et performance, unité de recherche clinique et de recherche en soins, Hôpitaux Champagne Sud, 101 avenue Anatole-France, 10000 Troyes, France
| | - Jan Chrusciel
- Pôle territorial santé publique et performance, unité de recherche clinique et de recherche en soins, Hôpitaux Champagne Sud, 101 avenue Anatole-France, 10000 Troyes, France
| | - Arthur Kaladjian
- Pôle de psychiatrie des adultes, centre hospitalier universitaire de Reims, faculté de médecine de Reims, rue du Général-Koenig, 51100 Reims, France
| | - Stéphane Sanchez
- Pôle territorial santé publique et performance, unité de recherche clinique et de recherche en soins, Hôpitaux Champagne Sud, 101 avenue Anatole-France, 10000 Troyes, France.
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Mohammed-Durosinlorun A, Mamoon N, Yakasai B. Screening for postpartum depression by health-care workers in Kaduna, North-Western Nigeria: A cross sectional study. JOURNAL OF CLINICAL SCIENCES 2022. [DOI: 10.4103/jcls.jcls_38_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Airey ND, Iqbal Z. Are Clinicians Confident in the Risk Assessment of Suicide?: A Systematic Literature Review. Arch Suicide Res 2022; 26:1-13. [PMID: 32669055 DOI: 10.1080/13811118.2020.1792019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Suicide reduction is recognized as a vital focus for mental health clinicians. Clinician confidence to undertake suicide risk assessment, though poorly understood, appears related to job performance, though overconfidence has also been evident in clinical practice. A systematic literature search was undertaken on PSYCinfo and MEDLINE using the terms: suicide risk assessment, confidence, clinician. Of 192 papers identified, 10 articles were deemed pertinent. These for the most part suggested clinician confidence above the 50% chance level though statistical evidence was lacking for all but two. The literature fails to provide sufficient and objective evidence of the impact of clinician confidence in practice. Recommendations are provided for future research.
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LeCloux M, Aguinaldo LD, Lanzillo EC, Horowitz LM. PCP Opinions of Universal Suicide Risk Screening in Rural Primary Care: Current Challenges and Strategies for Successful Implementation. J Rural Health 2020; 37:554-564. [PMID: 32845543 DOI: 10.1111/jrh.12508] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Universal suicide risk screening has the potential to address the disproportionately high rates of suicide in the rural United States, as 83% of people who have died by suicide have visited a health care provider in the year prior to their deaths, and rural patients are more likely to visit medical professionals than behavioral health professionals for mental health concerns. This study describes the opinions of primary care providers (PCPs) practicing in a primarily rural state regarding universal suicide risk screening, barriers to implementation, and strategies to increase the feasibility of screening in their practices. METHODS In-depth, individual semistructured qualitative interviews were conducted with a sample of PCPs practicing in West Virginia (N = 15). Applied thematic analysis of the data was completed by a team of 3 coders using a consensus-coding methodology. FINDINGS The majority of PCPs supported the practice of screening, but they identified multiple barriers, including a lack of access to mental health and crisis support services, concerns about clinic flow and follow-up with suicidal patients, cultural beliefs specific to rural Appalachia, and provider discomfort with screening. Strategies suggested to address these barriers included the use of technology for screening, a multidisciplinary team approach, streamlined methods for screening and risk assessment, co-located behavioral health, and additional trainings for PCPs on the topic of suicide. CONCLUSION Future research should examine the efficacy of universal suicide risk screening programs in rural adult primary care that utilize these strategies in diverse samples with longitudinal data.
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Affiliation(s)
- Mary LeCloux
- School of Social Work, West Virginia University, Morgantown, West Virginia
| | - Laika D Aguinaldo
- Department of Psychiatry, University of California, San Diego, California
| | | | - Lisa M Horowitz
- Office of the Clinical Director, National Institute of Mental Health Intramural Research Program, Bethesda, Maryland
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Coppens E, Van Audenhove C, Gusmão R, Purebl G, Székely A, Maxwell M, Koburger N, Arensman E, Hegerl U. Effectiveness of General Practitioner training to improve suicide awareness and knowledge and skills towards depression. J Affect Disord 2018; 227:17-23. [PMID: 29049931 DOI: 10.1016/j.jad.2017.09.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/14/2017] [Accepted: 09/23/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND General Practitioners (GPs) are well placed as gatekeepers for managing depression and suicidal ideation but not always well prepared. Capacity building has therefore been recommended as a useful strategy for suicide prevention. This study aimed to examine whether GPs' knowledge and attitudes towards and confidence to deal with depression and suicide improve after following a training program. METHODS As part of the OSPI-Europe multilevel intervention, a standardized training on depression and suicide was provided to 208 GPs in three European countries. Core outcomes were assessed using the Depression Attitude Questionnaire, the Attitude towards Suicide Prevention Scale, and the Morriss Confidence Scale. Data were collected before and after training, and at three to six months follow-up. RESULTS At baseline, GPs demonstrated various stigmatizing attitudes towards depression and low optimism about the therapeutic treatment of depression. They showed moderately positive attitudes towards suicide prevention but felt little confident in dealing with depression and suicide in daily practice. The training resulted in improved knowledge, attitudes and confidence regarding depression and suicide and their prevention and treatment. At follow-up, only the increase in confidence to deal with depression and suicide was sustained. LIMITATIONS The Depression Attitude Questionnaire has rather weak psychometric properties. Other external factors may have contributed to the observed training effects as the study included no control group. CONCLUSIONS The OSPI-Europe training program was able to improve the GPs' attitudes towards suicide prevention, several attitudes towards depression and its treatment as well as the GPs' confidence to deal with depression and suicide in everyday practice. At follow, only the GPs' confidence to deal with depression and suicide was preserved.
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Affiliation(s)
- Evelien Coppens
- LUCAS, Centre for Care Research and Consultancy, University of Leuven, Belgium
| | | | - Ricardo Gusmão
- CEDOC, Departamento de Saúde Mental, Faculdade de Ciências Médicas da Universidade NOVA de Lisboa, Portugal
| | - György Purebl
- Institute of Behavioural Sciences, Semmelweis University Budapest, Hungary
| | - András Székely
- Institute of Behavioural Sciences, Semmelweis University Budapest, Hungary
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, Faculty of Health Sciences and Sport, University of Stirling, United Kingdom
| | - Nicole Koburger
- Depression Research Centre, German Depression Foundation, Leipzig, Germany
| | - Ella Arensman
- National Suicide Research Foundation & Department of Epidemiology and Public Health, University College Cork, Ireland
| | - Ulrich Hegerl
- Depression Research Centre, German Depression Foundation, Leipzig, Germany; Department of Psychiatry and Psychotherapy, University of Leipzig, Germany
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LeCloux M. The Development of a Brief Suicide Screening and Risk Assessment Training Webinar for Rural Primary Care Practices. RURAL MENTAL HEALTH 2018; 42:60-66. [PMID: 32483470 PMCID: PMC7263742 DOI: 10.1037/rmh0000087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although primary care practices have the potential to be crucial intervention points for suicide prevention in rural areas of the United States, primary care staff are often underequipped to deal with suicide and have limited access to high-quality training opportunities on this topic. This manuscript reports on posttest data collected from a sample of primary care staff (N = 16) regarding the acceptability of a brief, online interactive training webinar designed for primary care practices in rural West Virginia. The majority of participants reported the webinar was relevant to their practices (73.3%) and that they would recommend it to a fellow professional (75.0%). Higher proportions of participants reported confidence (75.0%) and comfort (68.8%) asking patients about suicide than they did regarding their ability to complete a risk assessment (50.1%) and a safety plan (56.3%) with a suicidal individual. Only half (56.3%) thought it was important to screen all primary care patients for suicide. Future research should use tracked pre- and posttest data to evaluate the effectiveness of trainings that include a focus on risk assessment and safety planning, education about the potential benefits of universal suicide risk screening, and that can be delivered through asynchronous methods.
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Bocquier A, Pambrun E, Dumesnil H, Villani P, Verdoux H, Verger P. Physicians' characteristics associated with exploring suicide risk among patients with depression: a French panel survey of general practitioners. PLoS One 2013; 8:e80797. [PMID: 24339883 PMCID: PMC3858232 DOI: 10.1371/journal.pone.0080797] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 10/04/2013] [Indexed: 12/22/2022] Open
Abstract
Background General practitioners (GPs) have a key role to play in suicide prevention, but the rates at which they question patients with depression about suicidal thoughts and plans are rather low. Little is known about GPs' characteristics associated with such inquiries. Our objectives were to describe GPs' attitudes, perceived barriers, and self-reported practices in this questioning of these patients and to analyze factors associated with these practices. Methodology This cross-sectional survey was conducted among participants in a panel of randomly selected French GPs (1249/1431 participated: 87.3%). GPs were interviewed with a standardized questionnaire covering their professional and personal characteristics, attitudes, and practices in exploring the suicide risk of their patients with depression. We built a suicide inquiry score by summing the responses to 5 items and used a multiple linear regression analysis to explore the characteristics associated with this score. Principal Findings Most GPs reported inquiring about the presence of suicidal ideation often or very often; less than 30% reported that they frequently explored signs of a specific suicide plan. The mean suicide inquiry score was 12.4 (SD, 2.9; range, 5–20). False ideas, such as thinking that patients who report suicidal ideas do not often commit suicide, were frequent (42.3%). Previous continuing medical education on suicide, participation in a formal mental health network, and patients who committed suicide in the past 5 years were associated with a higher score. Reluctance to question patients about suicide and perception of insufficient skill were associated with a lower score. Conclusions/Significance This study showed great variability in French GPs' practices in exploring suicide risk in patients with depression. Interventions aiming at improving GPs' initial training and continuing medical education in suicide and/or depression, and their collaboration with mental health specialists should be developed, and their impacts assessed.
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Affiliation(s)
- Aurélie Bocquier
- INSERM, UMR912 “Economics and Social Sciences Applied to Health & Analysis of Medical Information” (SESSTIM), Marseille, France
- Aix Marseille University, UMR_S912, IRD, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- * E-mail:
| | - Elodie Pambrun
- Bordeaux University, U657, Bordeaux, France
- INSERM, U657, Bordeaux, France
| | - Hélène Dumesnil
- INSERM, UMR912 “Economics and Social Sciences Applied to Health & Analysis of Medical Information” (SESSTIM), Marseille, France
- Aix Marseille University, UMR_S912, IRD, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | | | - Hélène Verdoux
- Bordeaux University, U657, Bordeaux, France
- INSERM, U657, Bordeaux, France
| | - Pierre Verger
- INSERM, UMR912 “Economics and Social Sciences Applied to Health & Analysis of Medical Information” (SESSTIM), Marseille, France
- Aix Marseille University, UMR_S912, IRD, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
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Portella CH, Moretti GP, Panatto AP, Rosa MI, Quevedo J, Simões PWTA. Epidemiological profile of suicide in the Santa Catarina Coal Mining Region from 1980 to 2007. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2013; 35:128-33. [DOI: 10.1590/s2237-60892013000200006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 09/26/2012] [Indexed: 05/28/2023]
Abstract
BACKGROUND: Suicide is a public health problem worldwide. Estimates have indicated that over 1 million people commit suicide every year all over the world. Brazil has a moderate suicide death rate (4.1 per 100,000 inhabitants), but the fact that it is a large country leads to the coexistence of diverse characteristics and levels of development across the different Brazilian regions. In this sense, the South region has been shown to present suicide rates above the national average. OBJECTIVE: To estimate the profile of suicide in municipalities comprising the Santa Catarina Coal Mining Region from 1980 to 2007. METHODS: This ecological, time-series, descriptive study sought to characterize epidemiological aspects related to suicide method, marital status, sex, age, and occupation in the municipalities of the region in the years 1980 to 2007. RESULTS: A total of 474 suicides occurred in the period, yielding a mean death rate of 10.83 per 100,000 inhabitants. There was a predominance of males, at a 5:1 ratio, and a peak rate in the 55-64-year age group (11.31 per 100,000 inhabitants). The suicide method most commonly used was hanging (72%) and the most frequent occupation was hard labor work (11.60%); in relation to marital status, married subjects (48%) were the ones with the highest rates of suicide. CONCLUSIONS: The Santa Catarina Coal Mining Region has suicide mortality rates above the national average. This study highlights specific characteristics of suicide in the region and may contribute to the development of preventive measures.
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Taur FM, Chai S, Chen MB, Hou JL, Lin S, Tsai SL. Evaluating the suicide risk-screening scale used by general nurses on patients with chronic obstructive pulmonary disease and lung cancer: a questionnaire survey. J Clin Nurs 2011; 21:398-407. [DOI: 10.1111/j.1365-2702.2011.03808.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mitchell AJ, Vahabzadeh A, Magruder K. Screening for distress and depression in cancer settings: 10 lessons from 40 years of primary-care research. Psychooncology 2011; 20:572-84. [PMID: 21442689 DOI: 10.1002/pon.1943] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 01/10/2011] [Accepted: 01/25/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE There has been at least 40 years of active research on screening for depression and distress in primary care. Both successes and failures have been documented. The purpose of this focussed narrative review was to summarise this research and present the key lessons for clinicians and researchers working in psychosocial oncology. METHODS We searched for studies assessing the utility of screening in primary care in seven electronic bibliographic databases (CENTRAL, CINAHL, Embase, HMIC, Medline, PsycINFO, Web of Knowledge) from inception to December 2010. Results were reviewed and summarised into key areas. RESULTS We found that research could be distilled into the following key learning points. (1) Primary care is an important partner in psychosocial care. (2) Both over and under detection are problematic. (3) Barriers to identification involve patient and clinician factors. (4) Acceptability of screening is critical to implementation. (5) Underserved groups need special attention in screening. (6) Patient-clinician trust is an important modifiable variable. (7) Greater contact influences detection. (8) Clinician confidence/skills influence screening success and subsequent action. (9) Training may improve confidence but effects upon long-term outcomes are modest. (10) Screening is generally ineffective without aftercare. CONCLUSIONS Primary care has shown largely what does not work in relation to screening. Namely relying on clinicians' unassisted judgement without infrastructural support, using over-complex scales with low acceptability, looking for depression alone, using screening without linked treatment, treating in the absence of follow-up and failing to engage patients in their own care. These pitfalls can and should be avoided in psychosocial oncology.
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Taliaferro LA, Borowsky IW. Perspective: Physician education: a promising strategy to prevent adolescent suicide. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:342-347. [PMID: 21248597 DOI: 10.1097/acm.0b013e31820984ad] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Many young people who present to primary care providers (PCPs) have high levels of emotional distress and/or suicidal ideation. Therefore, PCPs are in an ideal position to recognize and respond to early symptoms and distress signals that accompany suicide warning signs, yet they underrecognize mood disorders and suicidality among youth. Medical school and residency programs typically provide inadequate training on pediatric mental health and adolescent suicide prevention. Thus, PCPs lack complete knowledge of risk factors and feel unprepared to handle mental health problems among youth. In this article, the authors provide an overview of the epidemiology of adolescent suicide and describe risk factors, protective factors, and warning signs. They propose that physician education represents a promising strategy to prevent adolescent suicide, and they establish the need for improved educational opportunities that would provide PCPs with the necessary skills and supports to identify and respond to psychosocial concerns that may increase suicide risk among youth. They recommend strategies, methods, and content areas for addressing educational gaps, as well as organizational approaches to support enhanced physician education. They also suggest areas for future research.
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Affiliation(s)
- Lindsay A Taliaferro
- Healthy Youth Development Prevention Research Center, Division of Adolescent Health and Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota 55414, USA.
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Pepin R, Segal DL, Coolidge FL. Intrinsic and extrinsic barriers to mental health care among community-dwelling younger and older adults. Aging Ment Health 2009; 13:769-77. [PMID: 19882416 DOI: 10.1080/13607860902918231] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study examined intrinsic and extrinsic barriers to mental health care among younger (n = 76; M age = 23 years) and older adults (n = 88; M age = 71 years) using a new 56 item self-report measure, Barriers to Mental Health Services Scale (BMHSS). The BMHSS was developed to examine 10 barriers to the utilization of mental health services: help-seeking attitudes, stigma, knowledge and fear of psychotherapy, belief about inability to find a psychotherapist, belief that depressive symptoms are normal, insurance and payment concerns, ageism, concerns about psychotherapist's qualifications, physician referral, and transportation concerns. Results indicated that younger adults perceived fear of psychotherapy, belief about inability to find a psychotherapist, and insurance concerns to be greater barriers than older adults. Men perceived stigma to be a greater barrier than women whereas women perceived finding a psychotherapist to be a greater barrier than men. The rank order of the BMHSS subscales was strongly similar for younger and older adults (r = 0.90, p = 0.000). These results also provide further evidence that stigma about receiving mental health services is not a primary barrier among younger or older adults.
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Affiliation(s)
- Renee Pepin
- Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs, CO 80933-7150, USA
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Verger P, Brabis PA, Kovess V, Lovell A, Sebbah R, Villani P, Paraponaris A, Rouillon F. Determinants of early identification of suicidal ideation in patients treated with antidepressants or anxiolytics in general practice: a multilevel analysis. J Affect Disord 2007; 99:253-7. [PMID: 17020784 DOI: 10.1016/j.jad.2006.09.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Revised: 09/06/2006] [Accepted: 09/08/2006] [Indexed: 11/15/2022]
Abstract
BACKGROUND General practitioners (GPs) play a key role in identifying and managing patients with suicidal tendencies. Few studies, however, examine both GP and patient characteristics and GP practices associated with suicide assessment. This article aims to evaluate 1) GPs' success in early identification of suicidal ideation (SI) in patients starting antidepressant or anxiolytic treatment, and 2) patient- and GP-related factors associated with this success. METHODS Survey of 144 GPs practising in southeastern France and of consecutive adults consulting them during June-October 2004 and prescribed antidepressant or anxiolytic treatment. Data were collected from GPs (consultation-questionnaires focusing on their prescription, diagnosis and detection of SI) and patients (self-administered questionnaires including the Hospital Anxiety and Depression scale and social and demographic characteristics). We used multilevel logistic regression to analyse factors associated with SI detection. RESULTS GPs completed consultation-questionnaires for 713 patients, 405 of whom completed self-administered questionnaires. Eighty-nine patients (22%) reported SI; in 43 cases (48%) SI had not been detected by the GP. GPs detected SI more frequently when they had completed continuing medical education about depression, when patients had higher depressive symptom scores, and when consultations were relatively long. LIMITATIONS Study limited to patients receiving initial prescriptions for antidepressants or anxiolytics. CONCLUSIONS The percentage of undetected SI in this study population was high. Additional training of GPs increases the chances of detecting SI. Medical training and continuing medical education should include better instruction about SI risk factors and diagnosis, including non-major depressions, and stress that screening requires sufficient consultation time.
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Affiliation(s)
- Pierre Verger
- Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseilles, France.
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Enochs WK, Young M, Choate RO. Counselors and Physicians Providing Mental Health Services: An Integrated Approach. ADULTSPAN JOURNAL 2006. [DOI: 10.1002/j.2161-0029.2006.tb00021.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Zeppegno P, Manzetti E, Valsesia R, Siliquini R, Ammirata G, De Donatis O, Usai C, Torre E. Differences in suicide behaviour in the elderly: a study in two provinces of Northern Italy. Int J Geriatr Psychiatry 2005; 20:769-75. [PMID: 16035130 DOI: 10.1002/gps.1354] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND to investigate the suicide phenomenon among the elderly (people aged 65 and over) in the Italian provinces of Novara and Verbania, in the time span between January 1990 and December 2000, in order to evaluate if the characteristics of the suicide behaviour correlate to the place of living with particular attention to the psychosocial factors. METHODS the information was collected from the Republic Procuration of the two provinces. Frequencies and contingency tables were evaluated to compare the data found in the two provinces. Standardised Mortality Ratios (SMRs) with their confidential intervals (95% confidence intervals) were calculated in comparison with the average suicide rates in North West Italy in the same period and in the same age group. RESULTS One hundred and eighty-four suicides were committed from the elderly, with an average rate of 14.07 per 100 000 inhabitants in Novara and 25.56 in Verbania. The most common methods used to commit suicide were hanging and jumping from height. The factors chiefly related to suicide were mental disease, followed by organic illness. The analysis of SMRs point out that the incidence of suicide in the province of Verbania is higher than in North West Italy while in Novara it is lower. CONCLUSION the evaluation of the suicide risk in the elderly in a diagnostic and preventive framework must take into consideration the psychosocial factors that vary with the place of living.
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Affiliation(s)
- P Zeppegno
- Psychiatric Clinic, Department of Medical Science, School of Medicine, University of Eastern Piedmont, Amedeo Avogadro, Novara, Italy.
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Schulberg HC, Bruce ML, Lee PW, Williams JW, Dietrich AJ. Preventing suicide in primary care patients: the primary care physician's role. Gen Hosp Psychiatry 2004; 26:337-45. [PMID: 15474633 DOI: 10.1016/j.genhosppsych.2004.06.007] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2004] [Accepted: 06/28/2004] [Indexed: 11/15/2022]
Abstract
Suicide is a critical public health problem that primary care physicians potentially can help address given that distressed patients frequently visit them in the weeks and months preceding the successful suicide. This article considers factors placing the patient at high risk for successful suicide and clinical assessment techniques available to the primary care physician. Patients who wish to harm themselves but still lack an articulated plan for doing so can be treated by the primary care physician with the monitoring assistance of a depression care manager and appropriate consultation by a mental health specialist.
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LaRocco-Cockburn A, Melville J, Bell M, Katon W. Depression screening attitudes and practices among obstetrician-gynecologists. Obstet Gynecol 2003; 101:892-8. [PMID: 12738146 DOI: 10.1016/s0029-7844(03)00171-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess obstetrician-gynecologists' attitudes and practices related to depression screening. METHOD A total of 282 obstetrician-gynecologists completed a 36-question mail survey that assessed attitudes regarding depression screening, training to treat depression, psychosocial concern, professional influence, and ease of screening. RESULT Depression screening (employed regardless of signs or symptoms) was reported by 44% of physicians. Positive attitudes toward depression screening, high psychosocial concern, high ease of screening, and adequate training to treat depression were significant independent predictors of depression screening practices. CONCLUSION The majority of obstetrician-gynecologists are concerned about depression, believe depression screening is effective, and perform some degree of depression screening with their patients. However, they perceive depression screening as difficult to carry out in everyday practice, and some question whether screening improves outcomes.
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Abstract
Older adults, and older men in particular, are the segment of the US population that has the highest suicide rate. Although research on risk factors continues to grow, there remains limited knowledge of the biologic changes that increase risk for suicide, as well as limited information about contributing psychosocial processes that extend beyond demographic factors. No proven interventions are known at this time, although efforts are underway to test approaches that reach older adults who use primary care services. Continued efforts are needed to change attitudes about mental illness and treatment in order to reach older adults who do not use health care services.
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Affiliation(s)
- Jane L Pearson
- National Institute of Mental Health, 6001 Executive Boulevard, Bethesda, MD 20892, USA.
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Current awareness in geriatric psychiatry. Int J Geriatr Psychiatry 2001. [PMID: 11607950 DOI: 10.1002/gps.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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