Last Updated: 2007-10-05 10:02:09 -0400 (Reuters Health)
NEW YORK (Reuters Health) – Primary care physicians do not consistently ask their depressed patients about suicide, according to research reported in the September/October issue of Annals of Family Medicine.
"Suicide is a preventable cause of mortality," first author Dr. Mitchell D. Feldman from University of California, San Francisco noted in comments to Reuters Health. "Patients frequently visit their doctor when they are depressed and while they may not feel comfortable initiating a conversation about suicide, they will usually share their thoughts and feelings with their doctor if it is broached in a respectful and sensitive manner."
To uncover factors associated with physician exploration of suicidality, the researchers had trained "patients" portraying major depression or adjustment disorder make visits to 152 primary care physicians between May 2003 and May 2004. Requests for antidepressant medication were made during some of these visits.
According to the researchers, the topic of suicide was broached by the physicians in only 36% of 298 encounters. "There is often a window of opportunity for doctors to screen for suicidality and intervene appropriately, but we found they frequently miss this opportunity," Dr. Feldman said.
Exploration of suicide was more common when the patient portrayed major depression versus adjustment disorder (42% vs 30%) and when they asked for an antidepressant medication (41%) versus when they did not make such a request (27%).
"We found that patients who make requests get more thorough and appropriate care, including more inquiries about suicide from their physician," Dr. Feldman noted. This finding "speaks to the potential value of disease awareness campaigns, mental health literacy programs, and patient activation programs," the authors point out.
"Training," Dr. Feldman concludes, "about how to appropriately diagnose and treat depression in the primary care setting, and specifically about the importance of asking depressed patients about the presence of suicidal thoughts, should start in medical school."
Ann Fam Med 2007;5:412-418.
