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Elzinga E, de Beurs DP, Beekman ATF, Maarsingh OR, Gilissen R. Nudging General Practitioners to explore suicidal thoughts among depressed patients. BMC Prim Care 2023; 24:88. [PMID: 37005569 PMCID: PMC10067310 DOI: 10.1186/s12875-023-02043-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/22/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND While frank discussion of suicidal thoughts in patients with depression is important for the prevention of suicide, suicide exploration of General Practitioners (GPs) is suboptimal. This study aimed to assess whether an intervention that prompts pop-up screens nudges GPs to more frequently explore suicidal thoughts over the course of two years. METHODS From January 2017 to December 2018, the intervention was incorporated in the information system of the Dutch general practice sentinel network. New registration of an episode of depression triggered a pop-up screen referring to a questionnaire about GPs' behaviour with regard to exploring suicidal thoughts. In two years, 625 questionnaires were completed by GPs and analysed using multilevel logistic regression analyses. RESULTS Compared to the first year, GPs were 50% more likely to explore suicidal thoughts among patients in the second year (OR 1.48; 95%CI 1.01-2.16). When adjusting for patients' gender and age we found that the effect of the pop-up screens disappeared (OR 1.33; 95% CI 0.90-1.97). Suicide exploration occurred less frequently in women than in men (OR 0.64; 95% CI 0.43-0.98) and in older compared to younger patients (OR 0.97; 95% CI 0.96-0.98 per year older). In addition, 26% of variation in suicide exploration was because of differences in general practice. There was no evidence that general practices developed differently over time. CONCLUSIONS Although low cost and easy to administer, the pop-up system was not effective in nudging GPs to explore suicidality more frequently. We encourage studies to test whether implementing these nudges as part of a multifaceted approach will lead to a stronger effect. Moreover, we recommend researchers to include more variables, such as work experience or previous mental health training, to better understand the effects of the intervention on GPs' behaviour.
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Affiliation(s)
- Elke Elzinga
- 113 Suicide prevention, research department, Paasheuvelweg 25, Amsterdam, 1105 BP, the Netherlands.
- Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Derek P de Beurs
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Research & Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Otto R Maarsingh
- Department of General Practice, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Renske Gilissen
- 113 Suicide prevention, research department, Paasheuvelweg 25, Amsterdam, 1105 BP, the Netherlands
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Elzinga E, Gilissen R, Beekman A, de Beurs D. Capturing patients’ satisfaction and experiences with suicide prevention in general practice: a bridge too far? Journal of Affective Disorders Reports 2023. [DOI: 10.1016/j.jadr.2023.100489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Elzinga E, Zomers M, van der Burg K, van Veen S, Schweren L, van Thiel G, van Wijngaarden E. Lifelong versus not lifelong death wishes in older adults without severe illness: a cross-sectional survey. BMC Geriatr 2022; 22:885. [PMID: 36411442 PMCID: PMC9680128 DOI: 10.1186/s12877-022-03592-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Some older adults with a persistent death wish without being severely ill report having had a death wish their whole lives (lifelong persistent death wish; L-PDW). Differentiating them from older adults without severe illness who developed a death wish later in life (persistent death wish, not lifelong; NL-PDW) can be relevant for the provision of adequate help and support. This study aims to gain insight into the characteristics, experiences, and needs of older adults with a L-PDW versus older adults with a NL-PDW and into the nature of their death wishes. METHODS In the Netherlands, in April 2019, a cross-sectional survey study was conducted among a large representative sample of 32,477 citizens aged 55 years and older. Respondents with a L-PDW (N = 50) were compared with respondents with a NL-PDW (N = 217) using descriptive statistics, Kruskal-Wallis tests, and Fisher's exact tests. RESULTS Respondents with a L-PDW were relatively younger and less often had (step)children. They less often looked back on a good and satisfying life with many good memories and more often reported trauma. Older adults with a NL-PDW more often reported loss and bereavement. Overall, the groups showed a lot of similarities. Both groups reported a death wish diverse in nature, numerous health problems, and a variety of needs for help and support. CONCLUSIONS Some of the differences we found between the groups might be particularly relevant for the provision of adequate help and support to older adults with a L-PDW (i.e., their past and trauma) and to older adults with a NL-PDW (i.e., their loss and bereavement). The heterogeneity of both groups and the diverse nature of their death wish indicate that careful assessment of the death wish, its background, and underlying needs is required to provide personalized help and support to older adults with a death wish.
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Affiliation(s)
- Elke Elzinga
- Research Department, 113 Suicide prevention, Paasheuvelweg 25, 1105 BP Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Margot Zomers
- grid.7692.a0000000090126352Department of Public Health, Healthcare Innovation & Evaluation and Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CX Utrecht, the Netherlands
| | - Kiki van der Burg
- grid.7692.a0000000090126352Department of Psychiatry, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Sisco van Veen
- Research Department, 113 Suicide prevention, Paasheuvelweg 25, 1105 BP Amsterdam, the Netherlands ,grid.509540.d0000 0004 6880 3010Department of Psychiatry & Department of Ethics, Law and Humanities, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Lizanne Schweren
- Research Department, 113 Suicide prevention, Paasheuvelweg 25, 1105 BP Amsterdam, the Netherlands
| | - Ghislaine van Thiel
- grid.7692.a0000000090126352Department of Public Health, Healthcare Innovation & Evaluation and Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CX Utrecht, the Netherlands
| | - Els van Wijngaarden
- grid.10417.330000 0004 0444 9382Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
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Elzinga E, de Beurs D, Beekman A, Berkelmans G, Gilissen R. Who didn't consult the doctor? Understanding sociodemographic factors in relation to health care uptake before suicide. J Affect Disord 2021; 287:158-164. [PMID: 33799033 DOI: 10.1016/j.jad.2021.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study aimed to establish differences between suicide decedents and a reference population across various health care settings. METHODS This population-wide registration study combined death statistics, sociodemographic data and health care data from Statistics Netherlands. From 2010 to 2016, 12,015 suicide cases and a random reference group of 132,504 were included and assigned to one of the three health care settings; mental health (MH) care, primary care or no care. Logistic regression analyses were performed to determine differences in suicide risk factors across settings. RESULTS In the 1-2 year period before suicide, 52% of the suicide decedents received MH care, 41% received GP care only and 7% received neither. Although sociodemographic factors showed significant differences across settings, the suicide risk profiles were not profoundly distinctive. A decreasing trend in suicide risk across health care settings became apparent for male gender, income level and being in a one-person or one-parent household, whereas for other factors (middle and older age, non-Western migration background, couples without children and people living in more sparsely populated areas), risk of suicide increased when health care setting became more specialized. LIMITATIONS Because of the data structure, 18 months of suicide decedents' health care use were compared with two years health care use of the reference group, which likely led to an underestimation of the reported differences. CONCLUSION Although there are differences between suicide decedents and a reference group across health care settings, these are not sufficiently distinctive to advocate for a setting-specific approach to suicide prevention.
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Affiliation(s)
- Elke Elzinga
- Research department, 113 Suicide Prevention, Amsterdam, Netherlands; Psychiatry, Amsterdam Public Health (research institute), Amsterdam UMC VU University, Amsterdam, Netherlands.
| | - Derek de Beurs
- Department of epidemiology, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, Netherlands
| | - Aartjan Beekman
- Department of Research & Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands; Psychiatry, Amsterdam Public Health (research institute), Amsterdam UMC VU University, Amsterdam, Netherlands
| | - Guus Berkelmans
- Research department, 113 Suicide Prevention, Amsterdam, Netherlands; National research institute for mathematics and computer science, Centrum Wiskunde & Informatica; CWI, Amsterdam, Netherlands
| | - Renske Gilissen
- Research department, 113 Suicide Prevention, Amsterdam, Netherlands
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van Mens K, Elzinga E, Nielen M, Lokkerbol J, Poortvliet R, Donker G, Heins M, Korevaar J, Dückers M, Aussems C, Helbich M, Tiemens B, Gilissen R, Beekman A, de Beurs D. Applying machine learning on health record data from general practitioners to predict suicidality. Internet Interv 2020; 21:100337. [PMID: 32944503 PMCID: PMC7481555 DOI: 10.1016/j.invent.2020.100337] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/29/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Suicidal behaviour is difficult to detect in the general practice. Machine learning (ML) algorithms using routinely collected data might support General Practitioners (GPs) in the detection of suicidal behaviour. In this paper, we applied machine learning techniques to support GPs recognizing suicidal behaviour in primary care patients using routinely collected general practice data. METHODS This case-control study used data from a national representative primary care database including over 1.5 million patients (Nivel Primary Care Database). Patients with a suicide (attempt) in 2017 were selected as cases (N = 574) and an at risk control group (N = 207,308) was selected from patients with psychological vulnerability but without a suicide attempt in 2017. RandomForest was trained on a small subsample of the data (training set), and evaluated on unseen data (test set). RESULTS Almost two-third (65%) of the cases visited their GP within the last 30 days before the suicide (attempt). RandomForest showed a positive predictive value (PPV) of 0.05 (0.04-0.06), with a sensitivity of 0.39 (0.32-0.47) and area under the curve (AUC) of 0.85 (0.81-0.88). Almost all controls were accurately labeled as controls (specificity = 0.98 (0.97-0.98)). Among a sample of 650 at-risk primary care patients, the algorithm would label 20 patients as high-risk. Of those, one would be an actual case and additionally, one case would be missed. CONCLUSION In this study, we applied machine learning to predict suicidal behaviour using general practice data. Our results showed that these techniques can be used as a complementary step in the identification and stratification of patients at risk of suicidal behaviour. The results are encouraging and provide a first step to use automated screening directly in clinical practice. Additional data from different social domains, such as employment and education, might improve accuracy.
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Affiliation(s)
- Kasper van Mens
- Altrecht Mental Healthcare, Utrecht, the Netherlands
- Trimbos Institute (Netherlands Institute of Mental Health), Utrecht, the Netherlands
| | - Elke Elzinga
- 113 Suicide Prevention, Amsterdam, the Netherlands
| | - Mark Nielen
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Joran Lokkerbol
- Trimbos Institute (Netherlands Institute of Mental Health), Utrecht, the Netherlands
| | - Rune Poortvliet
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Gé Donker
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Marianne Heins
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Joke Korevaar
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Michel Dückers
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Claire Aussems
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Marco Helbich
- Human Geography and Spatial Planning, Utrecht University, Utrecht, the Netherlands
| | - Bea Tiemens
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | | | - Aartjan Beekman
- Psychiatry, Amsterdam Public Health (research institute), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Derek de Beurs
- Trimbos Institute (Netherlands Institute of Mental Health), Utrecht, the Netherlands
- Clinical Psychology, Amsterdam Public Health, Vrije Universiteit Amsterdam, the Netherlands
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Abstract
OBJECTIVES This paper aims to describe the degree to which general practitioners (GPs) explore suicidal behaviour among depressed patients in the Netherlands. DESIGN An observational study of consultations between GPs and depressed patients. SETTING 39 sentinel GP practices within the Netherlands in 2017. PARTICIPANTS Patients with a registration of depression. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measure is suicide exploration by the GP. Secondary outcome measures at patient level, assessed by surveying GPs, include prevalence and severity of suicidal thoughts. Secondary outcome measures at GP level include follow-up actions of GP and reasons not to explore suicidality. RESULTS A total of 1034 questionnaires were included in the analyses. GPs assessed and explored suicidality in 44% of patients with depression (66% in patients with a new episode of depression). GPs explored suicidal feelings more often in patients with a new episode of depression (OR 4.027, p<0.001, 95% CI 2.924 to 5.588), male patients (OR 1.709, p<0.001, 95% CI 1.256 to 2.330) or younger patients (OR 1.017, p<0.001, 95% CI 1.009 to 1.026). Multilevel analysis showed that 22% of the variation in suicide exploration is due to differences in GP practice. Thirty-eight per cent of the patients who were asked by their GP, reported (severe) suicidal ideation. Most GPs (68%) did not explore suicidal feelings because they thought the patient would not be suicidal. CONCLUSION GPs explored suicidal thoughts in less than half of all depressed patients and in two-thirds of patients with a new episode of depression. Suicide prevention training is recommended to enhance suicide exploration.
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Affiliation(s)
- Elke Elzinga
- 113 Suicide Prevention, Amsterdam, The Netherlands
| | | | - Gé A Donker
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Aartjan T F Beekman
- Psychiatry, Amsterdam Public Health (research institute), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Derek P de Beurs
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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Donker G, Elzinga E, Gilissen R, de Beurs D. The feasibility of preventing suicide: the results of a Dutch intervention program. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- G Donker
- NIVEL Primary Care Database - Sentinel Practices, Utrecht, Netherlands
| | - E Elzinga
- NIVEL Primary Care Database - Sentinel Practices, Utrecht, Netherlands
| | - R Gilissen
- Department of Research, 113 Suicide Prevention, Amsterdam, Netherlands
| | - D de Beurs
- NIVEL Primary Care Database - Sentinel Practices, Utrecht, Netherlands
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