Is suicide prevention properly taught in medical schools?

Slovene Translation of the Difficulties in Suicidal Behaviors Intervention Questionnaire (DSBQ)

Background: Mental health professionals encounter numerous difficulties when working with suicidal clients. To understand these difficulties in clinical practice better, a valid instrument measuring them is needed. Aims: This study aimed to translate the Difficulties in Suicidal Behaviors Intervention Questionnaire (DSBQ) to Slovene, validate it, and explore Slovenian professionals' experiences with it. Method: The participants were 106 professionals (19 men, 87 women), aged 26-66 years. Apart from the DSBQ, scales on attitudes toward suicide prevention and coping strategies in difficult clinical situations were used. The data were collected between October 2017 and January 2019. Results: Although slightly diverging from the originally reported component structure, the Slovene translation of the DSBQ measures difficulties in working with suicidal clients with acceptable/good reliability and sensitivity, and adequate construct validity. Slovenian professionals most commonly experience difficulties related to working with children, followed by technical, system and setting, and other types of difficulties. Limitations: The sample of participants was relatively heterogeneous. Conclusion: Further studies of the DSBQ structure and validity, as well as difficulties, especially those related to working with children/adolescents and facing the theme of death, are warranted. Considering the difficulties most frequently reported in this investigation, more efforts are also needed in Slovenia to address technical and logistic aspects.

E-learning as a tool of suicide prevention training: A meta-analysis and systematic review

Suicide is a global health challenge. One prevention strategy is teaching individuals how to detect and respond to suicidality. These training have increasingly been delivered online. We searched WoS, Scopus, and PubMed from inception until the 20 September 2023 to evaluate e-learning efficacy as standardized mean changes and standardized mean differences. We synthesized main results using multilevel meta-analyses and subgroups using random-effects meta-analyses. Robins-I, RoB-II and trim-and-fill were used to assess the risk of bias. Of the 6516 initially screened articles, 26 were included. Overall, e-learning increased suicide prevention skills. Subgroups reported differing results: e-learning affected knowledge and self-efficacy more than behavior and attitudes. Efficacy, short duration, and low-cost suggest that e-learning may be feasible in teaching basic suicide prevention skills to lay people. However, current evidence suggests that health care professionals should not rely on e-learning as a training modality, except when no other form of training is available. Preregisteration: CRD42020218978.

Suicide prevention curriculum development for health and social care students: Protocol for a scoping review

Suicide has become a serious public health concern and international research has shown that the majority of individuals who die by suicide had receive healthcare in the year prior to their death. This presents an opportunity for suicide prevention by strategically training healthcare students in suicide prevention knowledge and skills. The objective of this scoping review is to identify literature that describes the design, development, implementation and/or evaluation of suicide prevention training for healthcare and/or social care students in higher education settings. Studies will only be considered eligible for inclusion if they describe the design, development, implementation and/or evaluation of suicide prevention curricula being delivered to healthcare or social care degree students in higher education. Quantitative, qualitative, and mixed method studies published between 2011 and 2023 (inclusive) and in the English language will be considered eligible. This scoping review will be conducted according to the PRISMA guidelines for scoping reviews (PRISMA-ScR). The developed search strategy will be implemented across six databases: PubMed, ERIC (Education Resources Information Center), PsycINFO, Embase, CINAHL and Web of Science. Several grey literature sources will also be consulted. Further potential results will be located by hand-searching the reference lists of included articles. The search strategy will include variations of the terms: 'student', 'suicide prevention' and 'education'. The search will be limited to titles, abstracts, and keywords in databases that allow it. Two reviewers will complete the screening using the predefined inclusion criteria. A third reviewer will resolve any conflicts during the screening and eligibility appraisal processes. Results will be presented in the form of tabulated results and an accompanying narrative summary, describing key findings and context related to learning outcomes, methodologies employed and implementation of the identified programmes.

Mental Health First Aid crisis role-plays between pharmacists and simulated patients with lived experience: a thematic analysis of debrief

PURPOSE

Healthcare professionals, including pharmacists, can recognise and assist people experiencing mental health crises. Despite this, little is known about how pharmacists assist and engage with people presenting with signs and symptoms of mental health crises. This study aimed to (i) examine pharmacists' mental health crisis assessment language during simulated patient role-plays (SPRPs) and (ii) explore participants' experiences of participating in SPRPs of Mental Health First Aid (MHFA) scenarios.

METHODS

Fifty-nine MHFA-trained pharmacy staff participated in audio-recorded SPRPs of three crisis scenarios enacted by a mental health consumer educator (MHCE). Post-SPRP, pharmacy staff members (including role-playing and observing participants), engaged in reflective debrief discussions with the facilitator and MHCEs. Debrief discussions were transcribed verbatim and analysed using inductive thematic analysis and suicide assessment language was explored.

RESULTS

The majority of role-playing pharmacists asked about suicidal ideation using appropriate, direct language (n = 8). Qualitative analyses of debrief discussions yielded four themes: (i) Relationship with the consumer, (ii) Verbal and non-verbal communication, (iii) Challenges with crisis assessment, which included difficulties associated with initiating conversations about suicide and mania, and (iv) Reflective learning.

CONCLUSION

While pharmacists demonstrated the appropriate suicide assessment language post-MHFA training, pharmacists felt uncomfortable initiating conversations around suicide and lacked confidence during crisis assessments. SPRPs provided pharmacists with opportunities to reflect on and practice MHFA skills in a safe learning environment. Future research exploring how MHFA training and SPRPs impact pharmacists' ability to provide MHFA in real-world settings is warranted.

Medical students' evaluation of a suicide prevention multimedia resource: A focus group study

AIMS

A series of podcasts and videos was created to assist medical students with learning about suicide prevention. The aim of this research was to explore medical students experiences of using a suicide prevention learning resource.

METHODS

A multimedia repository of learning resources for suicide prevention was designed and created for use across all years of the medical programme at The University of Auckland. Emphasis was placed on ensuring that the resource was culturally safe. The impact of the learning resource was evaluated with a qualitative approach using focus group methodology. Two focus groups were audio-recorded, transcribed and a thematic analysis was conducted employing three cycles of coding.

RESULTS

Three themes were identified: perceiving that suicide is complex and sensitive; tailoring knowledge to match students' developmental stage and context; and elements that facilitated interaction with the resource.

CONCLUSIONS

Suicide is unsurprisingly a challenging topic for medical students. The students in this study actively engaged with this resource on suicide prevention, which supplemented their core learning of the topic. Early access to resources developed in a culturally safe way within a spiral curriculum empowers students to understand that they have an important contribution to make in preventing suicide. This may prepare them for encountering suicide with peers, family members and in clinical practice.

Suicide as a medical education curricular topic: a documentary analysis of Brazilian federal medical schools

Purpose

Physicians worldwide need to be able to identify and assess suicide risk or behavior in their consults. The proper training of medical staff is an important form of suicide prevention, especially because 80% of the patients who died by suicide were in contact with a health-care service in the year of their death. The purpose of this study is to verify if some of the most important Brazilian medical schools includes discussions regarding suicide in their curricula, and describe them.

Design/methodology/approach

The study performed a documentary analysis of all Brazilian federal higher education institutions. The analysis involved selecting the institutions that approached the topic of suicide in their curricula, and sorting it by keywords. The curricula that contained such keywords were then entirely read, analyzed and all components found were described regarding course period, workload and approach.

Findings

Within the 68 analyzed institutions, 19 (28%) included suicide in their curricula with a total of 31 components approaching suicide among them. Those components belonged to different stages of the course and had different workloads and approaches. A total of seven different approaches were identified: Clinical (54.8%); Emergency (16.1%); Medical Psychology (9.7%); Ethics (6.5%); Social (6.5%); Occupational (3.2%) and Forensic (3.2%).

Originality/value

To the best of the authors’ knowledge, the study is the first to address medical education regarding suicide in a large number of Brazilian institutions. It is also one of the few studies worldwide to quantify suicide discussion on a large number of institutions using documentary analysis.

Late-life suicide in an aging world

Suicide is an important problem among older adults and in particular older men. Risk factors for suicide in older adults include the loss of a loved one, loneliness and physical illness. Suicide in older adults is often attributed to the development of depression due to bereavement or loss of physical health and independence. However, suicide prevention in old age requires avoiding overly simplistic therapeutic approaches. This Perspective discusses the impact of social determinants of health, cultural narratives and the coronavirus disease 2019 (COVID-19) pandemic on suicide among older adults and proposes strategies for a multifaceted approach to suicide prevention.

Risk factors for suicidal ideation and suicide attempt among medical students: A meta-analysis

Background

Medical training poses significant challenge to medical student wellbeing. With the alarming trend of trainee burnout, mental illness, and suicide, previous studies have reported potential risk factors associated with suicidal behaviours among medical students. The objective of this study is to provide a systematic overview of risk factors for suicidal ideation (SI) and suicide attempt (SA) among medical students and summarize the overall risk associated with each risk factor using a meta-analytic approach.

Methods

Systemic search of six electronic databases including MEDLINE, Embase, Education Source, Scopus, PsycInfo, and CINAHL was performed from database inception to March 19, 2021. Studies reporting original quantitative or epidemiological data on risk factors associated with SI and SA among undergraduate medical students were included. When two or more studies reported outcome on the same risk factor, a random-effects inverse variance meta-analysis was performed to estimate the overall effect size.

Results

Of 4,053 articles identified, 25 studies were included. Twenty-two studies reported outcomes on SI risk factors only, and three studies on both SI and SA risk factors. Meta-analysis was performed on 25 SI risk factors and 4 SA risk factors. Poor mental health outcomes including depression (OR 6.87; 95% CI [4.80–9.82] for SI; OR 9.34 [4.18–20.90] for SA), burnout (OR 6.29 [2.05–19.30] for SI), comorbid mental illness (OR 5.08 [2.81–9.18] for SI), and stress (OR 3.72 [1.39–9.94] for SI) presented the strongest risk for SI and SA among medical students. Conversely, smoking cigarette (OR 1.92 [0.94–3.92]), family history of mental illness (OR 1.79 [0.86–3.74]) and suicidal behaviour (OR 1.38 [0.80–2.39]) were not significant risk factors for SI, while stress (OR 3.25 [0.59–17.90]), female (OR 3.20 [0.95–10.81]), and alcohol use (OR 1.41 [0.64–3.09]) were not significant risk factors for SA among medical students.

Conclusions

Medical students face a number of personal, environmental, and academic challenges that may put them at risk for SI and SA. Additional research on individual risk factors is needed to construct effective suicide prevention programs in medical school.

Working with Young People at Risk of Suicidal Behaviour and Self-Harm: A Qualitative Study of Australian General Practitioners' Perspectives

General Practitioners (GPs) play a crucial role in the identification and support of young people at risk of suicidal behaviour and self-harm; however, no studies have explored GPs' perspectives, approaches, challenges, and resource needs when working with this cohort in an Australian setting. This was a qualitative study where fifteen GPs (Mage = 45.25 years) from multiple clinics in Western Australia took part in semi-structured interviews, and data were analysed thematically. Seven main themes were identified: (1) working with young people has its unique challenges; (2) screening and assessment tools can help to manage uncertainty and discomfort; (3) going beyond tools-the dialogue and relationship are most important; (4) there are limits to what we can offer in the time available; (5) the service access and referral pathways lack clarity and coordination; (6) the provision of mental health support should not fall on GPs alone; and (7) more comprehensive training in suicide and self-harm is needed. The findings highlight a number of opportunities to enhance care and better assist GPs working with young people who present with suicidal behaviour and self-harm, including considerations for conducting assessments, targeted resources such as training, and system and service improvements.

Suicidology Post Graduate Curriculum: Priority Topics and Delivery Mechanisms for Suicide Prevention Education

BACKGROUND

There has been limited attention to the development and delivery of tertiary suicide prevention curricula. The aim of this work was to describe the status of postgraduate suicide prevention education, with specific attention on examining the needs of the suicide prevention sector in Australia.

METHOD

An online survey was completed by 76 stakeholders in Australia. Current curriculum learning outcomes from Griffith University's postgraduate suicidology programs guided the development of the survey.

RESULTS

Four key learning domains were rated highest in importance by stakeholders. According to most stakeholders, skills-based qualifications were the most relevant type of qualification, and online modulized education was the most preferred delivery mode. Half of stakeholders supported suicide prevention professional development through a combination of financial support and study leave.

CONCLUSIONS

The survey provided invaluable feedback regarding the priorities of Australia's suicide prevention sector for content domains and delivery mechanisms for tertiary suicidology education. The findings showed the preferred type of organizational (employer) support that may be provided for employees to undertake such education. These findings will inform the future developments of Griffith University's suicidology programs and may motivate other universities to consider offering same or a similar type of education to support the suicide prevention sector toward saving lives.

Effectiveness of gatekeepers' training for suicide prevention program among medical professionals and medical undergraduate students of a medical college from Western India

INTRODUCTION

Suicide risk among Indigenous populations is a multifaceted phenomenon, influenced by biological, psychological, and social factors at the individual level, as well as cultural, political, and economic issues at the family and community level. The global prevalence of depression among medical students was recently estimated to be 28.0 % according to a meta-analysis of 77 studies. In the field of suicide prevention, the term gatekeeper refers to "individuals in a community who have face-to-face contact with large numbers of community members as part of their usual routine." They may be trained to "identify persons at risk of suicide and refer them to treatment or supporting services as appropriate". In our study we aimed to improved attitude and knowledge in gatekeeper to improve detection and referral of individuals who are at risk of suicide.

METHODS AND MATERIAL

We adapted an evidence-based gatekeeper training into a two-hour, multi-modal and interactive event for medical professional and undergraduate students. Then we evaluated the intervention compared to free-recall knowledge and attitudes questions were examined before and after participation in a student and faculty gatekeeper training program. Focus groups with students enriched interpretation of quantitative results.

STATISTICAL ANALYSIS USED

Knowledge, attitudes, and skills of both students and teachers were analyzed by Mann-Whitney U-test. Comparison of knowledge, attitudes, and skills between both groups was analyzed by Wilcoxon signed-rank test.

RESULTS

Undergraduate students developed more positive attitude for suicidal behavior where faculties developed more confident in their skill after training sessions.

CONCLUSION

brief gatekeeper training found effective in improving knowledge about suicide. Also, increasing participants' accuracy to identify warning signs, risk factors and protective factors about suicide.

Effectiveness of Brief Educational Training on Medical Students' Attitude toward Suicide Prevention

Objectives  Medical students are future physicians, and their attitude toward suicide attempters can impact outcome of patient management and quality of care. This study aimed to assess the effects of brief educational intervention on medical students' attitude toward suicide prevention.

Materials and Methods  The prospective study was conducted at a tertiary care center in northwestern India. The total enumeration method was employed to recruit 243 medical students. Attitude toward suicide prevention scale was applied before and after three hours’ training on management of suicide attempters and strategies for suicide prevention.

Statistical Analysis  Mean, median, standard deviation, frequencies, and percentages were calculated through descriptive statistics. Mean values were compared before and after the intervention through paired sample student's t -test. Chi-square test or Fischer exact test was used to compare categorical variables and p ≤ 0.05 was set for level of significance.

Results  Ten out of 14 attitudinal statements were significantly more favorable after imparting brief training on suicide prevention and management of suicide attempters. They reported lesser resentment, more responsible efforts, with greater competence and positive expectation associated with working for suicidal patients. They agreed on the need for multidisciplinary efforts for effective suicide prevention. After the intervention, they considered the possibility of suicidal ideas emerging due to the need for help, not for the purpose of attention-seeking, and instead of considering suicidal communication as individual's choice, they agreed on substantial preventability of suicide with comprehensive management. Their misconceptions were resolved to a greater extent.

Conclusion  Brief educational intervention was found effective in improving their attitude toward suicide prevention. The medical curriculum should incorporate regular educational programs, suicide prevention and comprehensive assessment, and management of suicide attempters.

The Hawai'i Child and Adolescent Psychiatry Resources for Primary Care: An Evidence-Informed Tool to Improve Quality of Care

Mental health continues to be a significant concern both globally and locally in Hawai'i, with nearly half of all mental illness beginning in childhood or adolescence. A shortage of mental health providers has led to less than a third of patients receiving appropriate and timely care. Primary care providers are often the first-line responders to untreated mental health conditions, but they are often underprepared to address these conditions. To help provide guidance to primary care providers and other first-line responders, a child and adolescent mental health resource manual was developed, that is tailored to Hawai'i. This manual was presented at several pediatric didactic sessions and general conferences to describe its evolution, utility, to elicit feedback, as well as for an initial distribution. While feedback was overall positive, future manual development and strategic updates will be made to insure its suitability and timeliness, while continuing circulation efforts to primary care providers will ultimately benefit a greater proportion of children in need.

Exploring Health Care Professionals' Knowledge of, Attitudes Towards, and Confidence in Caring for People at Risk of Suicide: a Systematic Review

Health care professionals are paramount to the prevention and management of suicidal thoughts and behaviors. Confidence in caring for people at risk of suicidal thoughts and behaviors is influenced by knowledge of and attitudes towards suicide. This systematic review aimed to explore health care professionals' knowledge of and attitudes towards suicide, as well as, their confidence in caring for people at risk of suicidal thoughts and behaviors. A systematic search of 4 electronic databases over 10 years was conducted. Following retrieval of 1,723 abstracts, 46 primary research publications were included, involving both cross-sectional (n = 27) and intervention study designs (n = 19). Knowledge of, attitudes towards, and confidence in caring for people at risk of suicidal thoughts and behaviors were explored among primary health care professionals, specialists, and health care students. The influence of training and education, type of health care professional, country of practice, and prior experience with suicide were highlighted among included studies. Health care professionals' knowledge of, attitudes towards and confidence in caring for people at risk of suicide are complex, interrelated constructs that shape their behaviors and may impact patient outcomes. Suicide training and education is necessary within health care curricula and as part of health care professionals' continuing professional development.

Confidence and attitudes of pharmacy students towards suicidal crises: patient simulation using people with a lived experience

PURPOSE

Health care professionals, including pharmacists, have the potential to recognise and assist those at risk of suicide. The primary aim of this study was to assess the impact of utilising people with a lived experience of mental illness as simulated patients on final year pharmacy students' attitudes toward and confidence in caring for people at risk of suicide after first receiving Mental Health First Aid (MHFA) training.

METHODS

A parallel group repeated measures design was used. People with a lived experience of mental illness enacted patients experiencing a mental health crisis, including possible suicidal ideation. Following MHFA training, the first group directly participated in the simulation, the second group observed, and the final group had no exposure to the simulation. Validated surveys measuring student attitudes and confidence were conducted at three time points; pre and post MHFA, and then at 2-4 weeks follow-up.

RESULTS

Full datasets of survey responses were received from 34/40 direct participants (85%), 104/146 observers (71%) and 50/66 comparison students (76%). Mean confidence scores significantly improved for all groups post MHFA training (p < 0.05). At follow-up, all 8 confidence items for the direct participant and observer group maintained significance from baseline to post intervention (p < 0.05). Mixed results in relation to attitudes towards suicide were evident at each time point and among each participant group.

CONCLUSIONS

Utilising people with a lived experience of mental illness as simulated patients has a positive effect on sustaining pharmacy student confidence in discussing suicidal behaviour post MHFA training. The inconsistency in attitudes towards suicide suggests that attitudes are complex in nature, involving multiple dynamic influences.

Effectiveness of General Practitioner training to improve suicide awareness and knowledge and skills towards depression

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.

Pharmacist training in suicide prevention

OBJECTIVE

Suicide in the United States is a major preventable public health problem. Pharmacists need to be educated on suicide prevention strategies so that they can increase their own awareness and identify patients at-risk. A training program for pharmacists was used to provide skills necessary to recognize a crisis and the warning signs of suicide. The program's effect on the participant's general perception, self-efficacy, and attitude towards suicide prevention was examined.

SETTING

Various academic, health care, and professional meetings throughout San Diego County.

PRACTICE INNOVATION

First Question, Persuade, and Refer training program targeting pharmacists.

EVALUATION

A self-administered presurvey, postsurvey and, Program Outcome Evaluation were given to participants of the suicide training program. Items included demographics, general perception, self-efficacy, and attitude toward suicide prevention. Descriptive statistics were used to describe participants' demographics. t tests were used to compare general perception, attitudes, and self-efficacy scores between pretest and post-program evaluation survey responses. Nonparametric Wilcoxon signed rank analyses for matched pairs were used to compare survey responses that asked about attitudes before and after trainings. Regression analyses were conducted to assess factors associated with general perception, self-efficacy, and attitudes.

RESULTS

Participants were more likely to update knowledge after training and reported more confidence to make an intervention for a patient at risk for suicide.

CONCLUSION

Our findings suggest that a suicide prevention training program helped pharmacist respondents build confidence in several self-efficacy areas relating to detection of suicide signs, response to patients with suicidal thoughts, reassurance for patients, and provision of resources and referrals.

Incentives for recruiting trainee participants in medical education research

INTRODUCTION

In the growing field of medical education research, participant recruitment can be challenging. Incentives, either tangible or intangible, may be offered to encourage participation. This study aimed to understand these incentives and explore the relationship between study quality and incentives in medical education research.

METHODS

We reviewed research studies examining medical trainees published in five major journals in 2008. Tangible and intangible incentives used in recruitment were extracted by two researchers. For each quantitative article, medical education research quality instrument (MERSQI) score was calculated and citation counts for all articles were compiled.

RESULTS

Of 215 included articles, 8% explicitly reported incentives. Tangible incentives (value range $15-$60 USD) were offered in 7.9% of studies. Intangible incentives were identified in 30% of studies but only one specifically discussed their use. Tangible incentives correlated with a higher MERSQI score (p < 0.001) and with citations (p < 0.001).

CONCLUSION

Most studies in medical education did not describe incentives for participation. Information regarding incentives should be reported in all studies to help inform future recruitment efforts and also to understand the study context including factors that may influence participants motivation.

A novel approach to suicide prevention - Educating when it matters

BACKGROUND

Looking at the burden of suicide, there is a dire need for medical schools to incorporate suicide prevention training. Effective communication helps in early detection and management of suicidal behavior. Medical students can act as a GATEKEEPER if they receive adequate training.

METHODOLOGY

This was an educational intervention study done at tertiary care teaching hospital to assess the knowledge and attitude of medical students toward depression and suicide and to impart and assess communication skills for suicide prevention in one of the four batches of students in 4^th semester. Pretest was conducted to assess knowledge and attitude toward depression and suicide, followed by training using interactive lectures, demonstration of interview, and hands-on training with patients and role-plays. The posttest and objective structured clinical examination (OSCE) were administered for skill assessment. Feedback was taken regarding this intervention.

RESULTS

The mean marks of the pre- and post-test were 8.96 (8.3-9.6) and 14.58 (13.8-15.3), respectively, out of 25. The difference was statistically significant (t = 13.24, P ≤ 0.0001) which suggests improvement in knowledge. We found mixed responses in attitude statements showing limited change. Mean obtained marks on OSCE examination out of 66 was 42.7. Among various components of OSCE, students scored high on rapport building. The most useful components of trainings were role-play, OSCE, and interaction with patients as per their feedback.

CONCLUSION

The intervention was found effective in increasing knowledge, changing attitude, and enhancing communication skills of medical students toward suicide prevention. Training of communication skills for suicide prevention in depressed person should be given to every medical student as suggested by feedback.

Training medical providers in evidence-based approaches to suicide prevention

Suicide is a significant issue in the United States and worldwide, and its prevention is a public health imperative. Primary care practices are an important setting for suicide prevention, as primary care providers have more frequent contact with patients at risk for suicide than any other type of health-care provider. The Western Interstate Commission for Higher Education, in partnership with the Suicide Prevention Resource Center, has developed a Suicide Prevention Toolkit and an associated training curriculum. These resources support the education of primary care providers in evidence-based strategies for identifying and treating patients at risk for suicide. The application of this curriculum to post-graduate medical training is presented here.

Suicide prevention competencies among urban Indian physicians: A needs assessment

INTRODUCTION

India accounts for the highest estimated number of suicides in the World. In 2012, more than 258,000 of the 804,000 suicide deaths worldwide occurred in India. Early identification and effective management of suicidal ideation and behavior are paramount to saving lives. However, mental health resources are often scarce and limited. Throughout India, there is a severe shortage in mental health professions trained, which results in a treatment gap of about 90%. A comprehensive needs assessment was undertaken to identify the nature of the deficits in suicide prevention training for physicians in three Indian cities: Mumbai, Ahmedabad, and Mysore.

MATERIALS AND METHODS

The study was carried out in several concurrent phases and used a mixed-method approach of converging quantitative and qualitative methodologies. Data were collected using survey questionnaires, focus groups, consultations, and environmental scans. A total of 46 physicians completed the questionnaire. Focus groups were conducted in Mumbai and Ahmedabad with 40 physicians. Consultations were carried out with psychiatrists and psychiatric residents from hospitals and clinics in Mumbai, Ahmedabad, and Mysore.

RESULTS

Training gaps in suicide prevention exist across the health care professions. Existing training lacks in both quality and quantity and result in critical deficits in core competencies needed to detect and treat patients presenting with suicidal ideation and behavior. Only 43% of the surveyed physicians felt they were competent to treat suicidal patients. The majority of surveyed physicians believed they would greatly benefit from additional training to enhance their suicide risk assessment and intervention skills.

CONCLUSIONS

There is a dire need for medical schools to incorporate suicide prevention training as a core component in their medical curricula and for continuing medical education training programs for physicians to enhance competencies in early detection and management of suicidal behavior.

The Opinions of GP's Patients About Suicide, Assisted Suicide, Euthanasia, and Suicide Prevention: An Italian Survey

A survey about opinions on end-of-life issues of a population represented by 1,171 people in the waiting room of general practitioners' surgeries was conducted in a province of northern Italy. Most subjects did not consider suicide as a reasonable option even in cases of a serious and incurable disease. Moreover, subjects did not consider euthanasia as a possible option either; however, they did express an opposite attitude when considering euthanasia in a third-person perspective. People with a personal history of suicidal behavior appear to present as a different population, overall expressing more open attitudes.

The impact of patient suicide and sudden death on health care professionals

OBJECTIVE

To compare the professional and personal impact of patient suicide and sudden death on health care professionals (HCPs) and determine factors associated with these impacts.

METHOD

The sample was derived from a sudden death-controlled psychological autopsy study of suicide. HCPs were identified by deceased's next of kin, by other HCPs, from coroners' files and from medical records. The HCPs were interviewed about their last contact with the deceased and the impact of the death on their lives.

RESULTS

Two hundred eleven HCPs were interviewed following suicide; 92 after sudden death. Suicide deaths were significantly more likely to impact upon the HCP's professional practice [suicide n = 79 (37.4%); sudden death n=9 (9.9%); χ(2) = 22.06, P < .001] and personal life [suicide deaths n = 55 (26.1%); sudden death n = 12 (13.0%); χ(2) = 5.58, P = .018] than sudden deaths. Using multinomial logistic regression, being female and suicide within a week of the consultation predicted professional and personal impacts; having less than 5 years experience predicted professional impact and receipt of support/counseling predicted personal impact.

CONCLUSION

Suicide deaths have a greater impact than sudden deaths upon the life of HCPs. Clinical inexperience influences impacts on professional practice and availability of support impacts on personal life.

Facing a Patient Who Seeks Help After a Suicide Attempt

Background: Although intervention with suicidal patients is one of the hardest tasks in clinical practice, little is known about health professionals’ perceptions about the difficulties of working with suicidal patients. Aims: The aims of this study were to: (1) describe the difficulties of professionals facing a suicidal patient; (2) analyze the differences in difficulties according to the sociodemographic and professional characteristics of the health professionals; and (3) identify the health professionals’ perceived skills and thoughts on the need for training in suicide. Method: A self-report questionnaire developed for this purpose was filled out by 196 health professionals. Exploratory principal components analyses were used. Results: Four factors were found: technical difficulties; emotional difficulties; relational and communicational difficulties; and family-approaching and logistic difficulties. Differences were found between professionals who had or did not have training in suicide, between professional groups, and between the number of patient suicide attempts. Sixty percent of the participants reported a personal need for training and 85% thought it was fundamental to implement training plans targeted at health professionals. Conclusion: Specific training is fundamental. Experiential and active methodologies should be used and technical, relational, and emotional questions must be included in the training syllabus.

Contacts with health professionals before suicide: missed opportunities for prevention?

AIM

This study aims to examine contacts with different health professionals in the three months prior to death in suicide cases compared to sudden death controls; and, to analyse contacts with health professionals among people who died by suicide having a diagnosable mental health disorder at the time of suicide compared to those who did not have such a diagnosis within four major groups of conditions.

METHODS

The psychological autopsy method was utilised to investigate suicides of individuals over the age of 35years. A case-control study design was applied using sudden death cases as controls. Odds ratios with a 95% confidence interval were calculated.

RESULTS

In total, 261 suicides and 182 sudden deaths were involved. In terms of contacts during the last three months prior to death, 76.9% of suicides and 81.9% of sudden deaths visited a general practitioner (GP). Persons who died by suicide had significantly more frequently contacts with mental health professionals than sudden death controls did. People with a diagnosable mental health disorder at the time of suicide attended GP surgeries with approximately the same frequency of people without a diagnosis at GP level.

CONCLUSION

Similarly, approximately 90% of people who die by suicide and by sudden death seek for help from health care system, mainly from GPs in three months prior to their death. With reference to health care contacts, people who had or did not have a diagnosable psychiatric disorder are not distinguishable at the GP surgery level.

Self-perceived Difficulties With Suicidal Patients in A Sample of Italian General Practitioners

Background

Suicidal behaviours are relatively common among primary care patients, but suicide ideation seems to be poorly detected by GPs. The purpose of the present study is to investigate the frequency of issues related to suicidal behaviour in GPs’ setting and to inquire the level of difficulties perceived by physicians when dealing with suicidal patients.

Methods

A survey on 88 GPs in Rovigo (Italy) has been conducted through the use of a self-administered questionnaire inquiring about suicidal behaviour in patients, personal history and outside professional lives.

Results

Four out of 5 doctors have encountered at least a case of suicide in their professional career, and 3 out of 4 recorded at least a case of suicide attempt in a working year. The frequency of personal history of suicidal ideation/behaviour was 2.3%. One third of GPs have come into contact with suicides or suicide attempts outside the professional setting. Sixty one per cent of doctors admitted difficulties in exploring suicidal ideation, but tended to ascribe it to a reluctant attitude of patients.

Conclusions

The study underscores GPs’ need of being helped in the difficult task of recognising suicidal patients.

Keywords

General practitioner; Suicide ideation; Suicide; Suicide attempt

'And then one day he'd shot himself. Then I was really shocked': general practitioners' reaction to patient suicide

OBJECTIVE

Patients who commit suicide have often seen their GP shortly before the suicide. This study explored the emotional effect of patients' suicides on GPs, and whether this effect was linked to the GPs' propensity to explore suicide risk.

METHODS

Semi-structured interviews were carried out with 14 GPs sampled purposively aiming at maximum variation. Analysis by Interpretative Phenomenological Analysis.

RESULTS

Patients' suicides had a substantial emotional effect on all GPs. Some developed a feeling of guilt and of having failed. If patients had contacted the GP about physical symptoms and the suicide ideation had not been diagnosed, this led to considerable self-scrutiny. GPs differed in their propensity to explore suicide ideation, but all were emotionally shaken and struck by guilt, failure, and self-scrutiny if a patient committed suicide.

CONCLUSION

A patient's suicide can be experienced as a 'critical case' that greatly affects all GPs irrespective of other differences among the GPs. The feeling of insufficiency was linked to not having realized during the visit that the patient may have had suicidal thoughts.

PRACTICE IMPLICATIONS

GPs' need for support in emotionally stressful situations should be investigated, and training should be directed towards discovering suicide ideation masked by vague physical symptoms.

Primary care contact prior to suicide in individuals with mental illness

BACKGROUND

Previous studies have reported differing rates of consultation with GPs prior to suicide. Patients with a psychiatric history have higher rates of consultation and consult closer to the time of their death.

AIM

To investigate the frequency and nature of general practice consultations in the year before suicide for patients in current, or recent, contact with secondary mental health services.

DESIGN OF STUDY

Retrospective case-note study and semi-structured interviews.

SETTING

General practices in the northwest of England.

METHOD

General practice data were obtained by a retrospective review of medical records (n = 247) and semi-structured interviews with GPs (n = 159).

RESULTS

GP records were reviewed in 247 of the 286 cases (86%). Overall, 91% of individuals (n = 224) consulted their GP on at least one occasion in the year before death. The median number of consultations was 7 (interquartile range = 3-10). Interviews were carried out with GPs with regard to 159 patients. GPs reported concerns about their patient's safety in 43 (27%) cases, but only 16% of them thought that the suicide could have been prevented. Agreement between GPs and mental health teams regarding risk of suicide was poor. Both sets of clinicians rated moderate to high levels of risk in only 3% of cases for whom information was available (n = 139) (overall kappa = 0.024).

CONCLUSION

Consultation prior to suicide is common but suicide prevention in primary care is challenging. Possible strategies might include examining the potential benefits of risk assessment and collaborative working between primary and secondary care.

Suicide intervention skills and related factors in community and health professionals

Health and community professionals have considerable exposure to suicidal people and need to be well skilled to deal with them. We assessed suicide intervention skills with a Dutch version of the SIRI in 980 health and community professionals and psychology students. Suicide intervention skills clearly differed among professional groups and were strongly related to experience, especially suicide-specific experience. Some community professionals scored below acceptable levels on their ability to respond appropriately to suicidal people they encounter, and tended to overestimate their skills level. Training is therefore indicated for these groups, and may be useful to more highly experienced groups too.