Log in

Addressing Suicidality in Primary Care Settings

  • Psychiatry in Primary Care (BN Gaynes, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Canada)

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. FASTSTATS – Suicide and Self-Inflicted Injury. http://www.cdc.gov/nchs/fastats/suicide.htm. Accessed 22 May 2012.

  2. FASTSTATS – Deaths and Mortality. http://www.cdc.gov/nchs/FASTATS/deaths.htm. Accessed 22 May 2012.

  3. Mościcki EK. Identification of suicide risk factors using epidemiologic studies. Psychiatr Clin North Am. 1997;20:499–517.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. •• 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..

    Article  PubMed  Google Scholar 

  6. • 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..

    Google Scholar 

  7. Skultety KM, Rodriguez RL. Treating geriatric depression in primary care. Curr Psychiatr Rep. 2008;10:44–50.

    Article  Google Scholar 

  8. •• 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..

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

  11. Jacobs D. A Resource Guide for Implementing The Joint Commission 2007 Patient Safety Goals on Suicide. 2007. http://www.sprc.org/sites/sprc.org/files/library/jcsafetygoals.pdf. Accessed 22 May 2012.

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. Heisel MJ, Duberstein PR, Lyness JM, Feldman MD. Screening for suicide ideation among older primary care patients. JABFM. 2010;23:260–9.

    Article  PubMed  Google Scholar 

  17. Heron M. Deaths: Leading causes for 2007. National Vital Statistics Reports. 2011;5.

  18. 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. 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.

    Google Scholar 

  20. Wintersteen MB. Standardized screening for suicidal adolescents in primary care. Pediatrics. 2010;125:938–44.

    Article  PubMed  Google Scholar 

  21. 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.

    Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. 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  Google Scholar 

  24. 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.

    Article  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. Graham RD, Rudd MD, Bryan CJ. Primary care providers' views regarding assessing and treating suicidal patients. Suicide Life Threat Behav. 2011;41:614–23.

    Article  PubMed  Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. • 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..

    Article  PubMed  Google Scholar 

  30. •• 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..

    Article  PubMed  Google Scholar 

  31. 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. 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.

    Google Scholar 

  33. Norris D, Clark MS. Evaluation and treatment of the suicidal patient. Am Fam Physician. 2012;85:602–5.

    PubMed  Google Scholar 

  34. 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.

    Article  PubMed  Google Scholar 

  35. 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.

    Article  Google Scholar 

  36. Kendall K, Wiles R. Resisting blame and managing emotion in general practice: the case of patient suicide. Soc Sci Med. 2010;70:1714–20.

    Article  PubMed  Google Scholar 

  37. • IMPACT: Building the Team. http://impact-uw.org/implementation/buildingteam.html. Accessed 29 April 2012. A well-organized online resource describing the IMPACT collaborative care model and providing connection to training resources for teams wanting to implement it in their own practices.

Download references

Disclosure

Dr. Bostwick reported no potential conflicts of interest relevant to this article.

Dr. Rackley receives grant support from the Maternal Child Health Bureau of the Health Resources and Services Administration for a Collaborative Office Rounds program with Primary Care Pediatricians.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J. Michael Bostwick.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bostwick, J.M., Rackley, S. Addressing Suicidality in Primary Care Settings. Curr Psychiatry Rep 14, 353–359 (2012). https://doi.org/10.1007/s11920-012-0286-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-012-0286-7

Keywords

Navigation