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Published in: Current Psychiatry Reports 4/2012

01-08-2012 | Psychiatry in Primary Care (BN Gaynes, Section Editor)

Addressing Suicidality in Primary Care Settings

Authors: J. Michael Bostwick, Sandra Rackley

Published in: Current Psychiatry Reports | Issue 4/2012

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Abstract

By design or by default, primary care providers (PCPs)are frequently the vanguard in the fight against suicide. Recent studies have highlighted programs to improve screening and prevention of suicidality in the medical home, particularly among high-risk patients, such as adolescents, the elderly, and veterans. Increasing efforts are also being paid to improving the PCP’s skill in assessing for suicidality. However, it is becoming increasingly apparent that screening alone will not significantly lower suicide rates until it occurs within a well-integrated system that facilitates timely referral to more intensive mental health services for those patients who need them. Unfortunately, such systems are sorely lacking in many, if not most, areas of the USA.
Literature
3.
go back to reference Mościcki EK. Identification of suicide risk factors using epidemiologic studies. Psychiatr Clin North Am. 1997;20:499–517.PubMedCrossRef Mościcki EK. Identification of suicide risk factors using epidemiologic studies. Psychiatr Clin North Am. 1997;20:499–517.PubMedCrossRef
4.
go back to reference Posner K, Oquendo MA, Gould M, Stanley B, Davies M. Columbia Classification Algorithm of Suicide Assessment (C-CASA): classification of suicidal events in the FDA's pediatric suicidal risk analysis of antidepressants. Am J Psychiatr. 2007;164:1035–43.PubMedCrossRef Posner K, Oquendo MA, Gould M, Stanley B, Davies M. Columbia Classification Algorithm of Suicide Assessment (C-CASA): classification of suicidal events in the FDA's pediatric suicidal risk analysis of antidepressants. Am J Psychiatr. 2007;164:1035–43.PubMedCrossRef
5.
go back to reference •• Gardner W, Klima J, Chisolm D, Feehan H, Bridge J, Campo J, et al. Screening, triage, and referral of patients who report suicidal thought during a primary care visit. Pediatrics. 2010;125:945–52. A large-scale program offering both improved screening for mental health issues and timely linkage to appropriate services for adolescents in primary care..PubMedCrossRef •• Gardner W, Klima J, Chisolm D, Feehan H, Bridge J, Campo J, et al. Screening, triage, and referral of patients who report suicidal thought during a primary care visit. Pediatrics. 2010;125:945–52. A large-scale program offering both improved screening for mental health issues and timely linkage to appropriate services for adolescents in primary care..PubMedCrossRef
6.
go back to reference • Taliaferro LA, Borowsky IW. Perspective: Physician education: a promising strategy to prevent adolescent suicide. Acad Med J Assoc Am Med Coll. 2011;86:342–7. A review of adolescent suicide prevention strategies particularly pertinent to primary care and a thoughtful analysis of gaps in medical education, with suggestions of ways to close the gaps.. • Taliaferro LA, Borowsky IW. Perspective: Physician education: a promising strategy to prevent adolescent suicide. Acad Med J Assoc Am Med Coll. 2011;86:342–7. A review of adolescent suicide prevention strategies particularly pertinent to primary care and a thoughtful analysis of gaps in medical education, with suggestions of ways to close the gaps..
7.
go back to reference Skultety KM, Rodriguez RL. Treating geriatric depression in primary care. Curr Psychiatr Rep. 2008;10:44–50.CrossRef Skultety KM, Rodriguez RL. Treating geriatric depression in primary care. Curr Psychiatr Rep. 2008;10:44–50.CrossRef
8.
go back to reference •• McDowell AK, Lineberry TW, Bostwick JM. Practical suicide-risk management for the busy primary care physician. Mayo Clin Proc. 2011;86:792–800. A brief review of data about suicide risk followed by a series of suggestions for the assessment of risk factors. Includes a table distinguishing suicide "warning signs," which are typically proximal and modifiable, from the traditional "risk factors" for suicide, which are often distal and unchanging..PubMedCrossRef •• McDowell AK, Lineberry TW, Bostwick JM. Practical suicide-risk management for the busy primary care physician. Mayo Clin Proc. 2011;86:792–800. A brief review of data about suicide risk followed by a series of suggestions for the assessment of risk factors. Includes a table distinguishing suicide "warning signs," which are typically proximal and modifiable, from the traditional "risk factors" for suicide, which are often distal and unchanging..PubMedCrossRef
9.
go back to reference Lake CR, Baumer J. Academic psychiatry's responsibility for increasing the recognition of mood disorders and risk for suicide in primary care. Curr Opin Psychiatry. 2010;23:157–66.PubMedCrossRef Lake CR, Baumer J. Academic psychiatry's responsibility for increasing the recognition of mood disorders and risk for suicide in primary care. Curr Opin Psychiatry. 2010;23:157–66.PubMedCrossRef
10.
go back to reference Screening For Mental Health I, Suicide Prevention Resource C. SAFE-T: Suicide Assessment Evaluation and Triage for Mental Health Professionals. Education Development Center, Inc.; 2009. Screening For Mental Health I, Suicide Prevention Resource C. SAFE-T: Suicide Assessment Evaluation and Triage for Mental Health Professionals. Education Development Center, Inc.; 2009.
12.
go back to reference Shemesh E, Annunziato RA, Rubinstein D, Sultan S, Malhotra J, Santra M, et al. Screening for depression and suicidality in patients with cardiovascular illnesses. Am J Cardiol. 2009;104:1194–7.PubMedCrossRef Shemesh E, Annunziato RA, Rubinstein D, Sultan S, Malhotra J, Santra M, et al. Screening for depression and suicidality in patients with cardiovascular illnesses. Am J Cardiol. 2009;104:1194–7.PubMedCrossRef
13.
go back to reference Lapierre S, Erlangsen A, Waern M, De Leo D, Oyama H, Scocco P, et al. A systematic review of elderly suicide prevention programs. Crisis. 2011;32:88–98.PubMedCrossRef Lapierre S, Erlangsen A, Waern M, De Leo D, Oyama H, Scocco P, et al. A systematic review of elderly suicide prevention programs. Crisis. 2011;32:88–98.PubMedCrossRef
14.
go back to reference Cohen A, Chapman BP, Gilman SE, Delmerico AM, Wieczorek W, Duberstein PR, et al. Social inequalities in the occurrence of suicidal ideation among older primary care patients. Am J Geriatr Psychiatr. 2010;18:1146–54.CrossRef Cohen A, Chapman BP, Gilman SE, Delmerico AM, Wieczorek W, Duberstein PR, et al. Social inequalities in the occurrence of suicidal ideation among older primary care patients. Am J Geriatr Psychiatr. 2010;18:1146–54.CrossRef
15.
go back to reference Kjølseth I, Ekeberg Ø, Steihaug S. Elderly people who committed suicide—their contact with the health service. What did they expect, and what did they get? Aging Mental Health. 2010;14:938–46.PubMedCrossRef Kjølseth I, Ekeberg Ø, Steihaug S. Elderly people who committed suicide—their contact with the health service. What did they expect, and what did they get? Aging Mental Health. 2010;14:938–46.PubMedCrossRef
16.
go back to reference Heisel MJ, Duberstein PR, Lyness JM, Feldman MD. Screening for suicide ideation among older primary care patients. JABFM. 2010;23:260–9.PubMedCrossRef Heisel MJ, Duberstein PR, Lyness JM, Feldman MD. Screening for suicide ideation among older primary care patients. JABFM. 2010;23:260–9.PubMedCrossRef
17.
go back to reference Heron M. Deaths: Leading causes for 2007. National Vital Statistics Reports. 2011;5. Heron M. Deaths: Leading causes for 2007. National Vital Statistics Reports. 2011;5.
18.
go back to reference Zuckerbrot RA, Cheung AH, Jensen PS, Stein REK, Laraque D. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, assessment, and initial management. Pediatrics. 2007;120:e1299-e312-e-e312. Zuckerbrot RA, Cheung AH, Jensen PS, Stein REK, Laraque D. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, assessment, and initial management. Pediatrics. 2007;120:e1299-e312-e-e312.
19.
go back to reference Williams SB, O'Connor EA, Eder M, Whitlock EP. Screening for child and adolescent depression in primary care settings: a systematic evidence review for the US Preventive Services Task Force. Pediatrics. 2009;123:e716-35-e-35. Williams SB, O'Connor EA, Eder M, Whitlock EP. Screening for child and adolescent depression in primary care settings: a systematic evidence review for the US Preventive Services Task Force. Pediatrics. 2009;123:e716-35-e-35.
20.
go back to reference Wintersteen MB. Standardized screening for suicidal adolescents in primary care. Pediatrics. 2010;125:938–44.PubMedCrossRef Wintersteen MB. Standardized screening for suicidal adolescents in primary care. Pediatrics. 2010;125:938–44.PubMedCrossRef
21.
go back to reference Horwitz SM, Kelleher KJ, Stein REK, Storfer-Isser A, Youngstrom EA, Park ER, et al. Barriers to the identification and management of psychosocial issues in children and maternal depression. Pediatrics. 2007;119:e208-18-e-18. Horwitz SM, Kelleher KJ, Stein REK, Storfer-Isser A, Youngstrom EA, Park ER, et al. Barriers to the identification and management of psychosocial issues in children and maternal depression. Pediatrics. 2007;119:e208-18-e-18.
22.
go back to reference Kataoka SH, Zhang L, Wells KB. Unmet need for mental health care among U.S. children: variation by ethnicity and insurance status. Am J Psychiatr. 2002;159:1548–55.PubMedCrossRef Kataoka SH, Zhang L, Wells KB. Unmet need for mental health care among U.S. children: variation by ethnicity and insurance status. Am J Psychiatr. 2002;159:1548–55.PubMedCrossRef
23.
go back to reference O'Connor EA, Whitlock EP, Beil TL, Gaynes BN. Screening for depression in adult patients in primary care settings: a systematic evidence review. Ann Int Med. 2009;151:793–803.PubMed O'Connor EA, Whitlock EP, Beil TL, Gaynes BN. Screening for depression in adult patients in primary care settings: a systematic evidence review. Ann Int Med. 2009;151:793–803.PubMed
24.
go back to reference Bryan CJ, Corso KA. Depression, PTSD, and suicidal ideation among active duty veterans in an integrated primary care clinic. Psychol Serv. 2011;8:94–103.CrossRef Bryan CJ, Corso KA. Depression, PTSD, and suicidal ideation among active duty veterans in an integrated primary care clinic. Psychol Serv. 2011;8:94–103.CrossRef
25.
go back to reference Denneson LM, Basham C, Dickinson KC, Crutchfield MC, Millet L, Shen X, et al. Suicide risk assessment and content of VA health care contacts before suicide completion by veterans in Oregon. Psychiatr Serv. 2010;61:1192–7.PubMedCrossRef Denneson LM, Basham C, Dickinson KC, Crutchfield MC, Millet L, Shen X, et al. Suicide risk assessment and content of VA health care contacts before suicide completion by veterans in Oregon. Psychiatr Serv. 2010;61:1192–7.PubMedCrossRef
26.
go back to reference Graham RD, Rudd MD, Bryan CJ. Primary care providers' views regarding assessing and treating suicidal patients. Suicide Life Threat Behav. 2011;41:614–23.PubMedCrossRef Graham RD, Rudd MD, Bryan CJ. Primary care providers' views regarding assessing and treating suicidal patients. Suicide Life Threat Behav. 2011;41:614–23.PubMedCrossRef
27.
go back to reference Hooper LM, Epstein SA, Weinfurt KP, Decoster J, Qu L, Hannah NJ. Predictors of primary care physicians' self-reported intention to conduct suicide risk assessments. J Behav Health Serv Res. 2012;39:103–15.PubMedCrossRef Hooper LM, Epstein SA, Weinfurt KP, Decoster J, Qu L, Hannah NJ. Predictors of primary care physicians' self-reported intention to conduct suicide risk assessments. J Behav Health Serv Res. 2012;39:103–15.PubMedCrossRef
28.
go back to reference Vannoy SD, Fancher T, Meltvedt C, Unützer J, Duberstein P, Kravitz RL. Suicide inquiry in primary care: creating context, inquiring, and following up. Ann Fam Med. 2010;8:33–9.PubMedCrossRef Vannoy SD, Fancher T, Meltvedt C, Unützer J, Duberstein P, Kravitz RL. Suicide inquiry in primary care: creating context, inquiring, and following up. Ann Fam Med. 2010;8:33–9.PubMedCrossRef
29.
go back to reference • Vannoy SD, Tai-Seale M, Duberstein P, Eaton LJ, Cook MA. Now what should I do? Primary care physicians' responses to older adults expressing thoughts of suicide. J Gen Intern Med. 2011;26:1005–11. In-depth analysis of interactions between older adults and their primary care physicians, with thoughtful categorization of barriers to open communication and suggestions for improvement..PubMedCrossRef • Vannoy SD, Tai-Seale M, Duberstein P, Eaton LJ, Cook MA. Now what should I do? Primary care physicians' responses to older adults expressing thoughts of suicide. J Gen Intern Med. 2011;26:1005–11. In-depth analysis of interactions between older adults and their primary care physicians, with thoughtful categorization of barriers to open communication and suggestions for improvement..PubMedCrossRef
30.
go back to reference •• Fowler JC. Suicide risk assessment in clinical practice: Pragmatic guidelines for imperfect assessments. Psychotherapy. 2012;49:81–90. An overview of the current data about what is known about how to assess and intervene with patients at risk for suicide. Includes review and discussion of the SAFE-T model for suicide risk assessment..PubMedCrossRef •• Fowler JC. Suicide risk assessment in clinical practice: Pragmatic guidelines for imperfect assessments. Psychotherapy. 2012;49:81–90. An overview of the current data about what is known about how to assess and intervene with patients at risk for suicide. Includes review and discussion of the SAFE-T model for suicide risk assessment..PubMedCrossRef
31.
go back to reference Practice Guideline for the Assessment and Treatment of Patients With Suicidal Behaviors. APA Practice Guidelines for the Treatment of Psychiatric Disorders: Comprehensive Guidelines and Guideline Watches. American Psychiatric Association, Arlington, VA; 2003. Practice Guideline for the Assessment and Treatment of Patients With Suicidal Behaviors. APA Practice Guidelines for the Treatment of Psychiatric Disorders: Comprehensive Guidelines and Guideline Watches. American Psychiatric Association, Arlington, VA; 2003.
32.
go back to reference American Academy of Child and Adolescent Psychiatry. Practice parameter for the assessment and treatment of children and adolescents with suicidal behavior. J Am Acad Child Adolesc Psychiatr. 2001;40 Suppl 7:24S–51. American Academy of Child and Adolescent Psychiatry. Practice parameter for the assessment and treatment of children and adolescents with suicidal behavior. J Am Acad Child Adolesc Psychiatr. 2001;40 Suppl 7:24S–51.
33.
go back to reference Norris D, Clark MS. Evaluation and treatment of the suicidal patient. Am Fam Physician. 2012;85:602–5.PubMed Norris D, Clark MS. Evaluation and treatment of the suicidal patient. Am Fam Physician. 2012;85:602–5.PubMed
34.
go back to reference Bell RA, Franks P, Duberstein PR, Epstein RM, Feldman MD. Fernandez y Garcia E, et al. Suffering in silence: reasons for not disclosing depression in primary care. Ann Fam Med. 2011;9:439–46.PubMedCrossRef Bell RA, Franks P, Duberstein PR, Epstein RM, Feldman MD. Fernandez y Garcia E, et al. Suffering in silence: reasons for not disclosing depression in primary care. Ann Fam Med. 2011;9:439–46.PubMedCrossRef
35.
go back to reference Davidsen AS. 'And then one day he'd shot himself. Then I was really shocked': general practitioners' reaction to patient suicide. Patient Educ Counsel. 2011;85:113–8.CrossRef Davidsen AS. 'And then one day he'd shot himself. Then I was really shocked': general practitioners' reaction to patient suicide. Patient Educ Counsel. 2011;85:113–8.CrossRef
36.
go back to reference Kendall K, Wiles R. Resisting blame and managing emotion in general practice: the case of patient suicide. Soc Sci Med. 2010;70:1714–20.PubMedCrossRef Kendall K, Wiles R. Resisting blame and managing emotion in general practice: the case of patient suicide. Soc Sci Med. 2010;70:1714–20.PubMedCrossRef
Metadata
Title
Addressing Suicidality in Primary Care Settings
Authors
J. Michael Bostwick
Sandra Rackley
Publication date
01-08-2012
Publisher
Current Science Inc.
Published in
Current Psychiatry Reports / Issue 4/2012
Print ISSN: 1523-3812
Electronic ISSN: 1535-1645
DOI
https://doi.org/10.1007/s11920-012-0286-7

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