Study Shows Physicians Do Not Consistently Inquire About Suicide with Patients Exhibiting Depressive

Mitchell Feldman, MD, MPhil, professor of medicine, Division of General Internal Medicine at UCSF, is lead author on a paper titled "Let's Not Talk About It: Suicide Inquiry in Primary Care" in the September/October issue of Annals of Family Medicine. Though the primary care setting presents an excellent venue for detection of and early intervention for suicide risk - up to 75 percent of people who commit suicide have seen a primary care clinician in the previous 30 days - the research study found that primary care physicians do not consistently inquire about suicidality. In a study of 152 physicians, suicide was explored in only 36 percent of 298 encounters with patient actors who portrayed depressive symptoms. One of the notable findings, according to Feldman, was that exploration was more common when patients portrayed major depression (versus adjustment disorder) and when they made a request for antidepressant medication. The latter finding was especially true when general, as opposed to brand name, antidepressant medication requests were made. Exploration was also more common in academic settings and among physicians who have had a personal experience with depression, whether in themselves, family members or close friends. The authors conclude that their findings suggest that one approach to improving the rate of physician recognition of suicidal thinking in depressed patients is through advertising or public service messaging that prompts patients to ask for help to treat depression without encouraging them to request specific antidepressant medications. The research was funded by a grant from the National Institute of Mental Health. Study co-authors are Peter Franks, MD, and Richard L. Kravitz, MD, Msph, University of California, Davis; Paul R. Duberstein, PhD, and Steven Vannoy, PhD, University of Rochester Medical Center, New York; and Ronald Epstein, MD, University of Rochester School of Medicine and Dentistry, New York.

Let's Not Talk About It: Suicide Inquiry in Primary Care Mitchell D. Feldman et al. Annals of Family Medicine (2007) 5:412-418 Abstract | Full Text | Full Text (PDF)

Related Links Doctors Often Fail to Spot Suicidal Patients The Washington Post, September 24, 2007 Docs and Suicide: "Let's Not Talk About It" Reuters Health, October 5, 2007