Practical Suicide-risk Management for the Busy Primary Care Physician

Overview

Journal Mayo Clin Proc

Specialty General Medicine

Date 2011 Jun 29

PMID 21709131

Citations 46

Authors

Anna K McDowell

Timothy W Lineberry

J Michael Bostwick

Affiliations

Soon will be listed here.

Abstract

Suicide is a public health problem and a leading cause of death. The number of people thinking seriously about suicide, making plans, and attempting suicide is surprisingly high. In total, primary care clinicians write more prescriptions for antidepressants than mental health clinicians and see patients more often in the month before their death by suicide. Treatment of depression by primary care physicians is improving, but opportunities remain in addressing suicide-related treatment variables. Collaborative care models for treating depression have the potential both to improve depression outcomes and decrease suicide risk. Alcohol use disorders and anxiety symptoms are important comorbid conditions to identify and treat. Management of suicide risk includes understanding the difference between risk factors and warning signs, developing a suicide risk assessment, and practically managing suicidal crises.

Citing Articles

"Suicide's very abstract": A qualitative analysis of risk assessment training recommendations from family physicians.

Dixon M, McNamara K, Moss D Qual Res Med Healthc. 2025; 8(3):12676.

PMID: 39906325 PMC: 11791472. DOI: 10.4081/qrmh.2024.12676.

Prevalence of suicide risk among a national sample of individuals referred from a primary care subpopulation, 2017-2020.

Little V, Gatanaga O, Hutchins S, Gloria C Health Aff Sch. 2024; 1(2):qxad029.

PMID: 38756240 PMC: 10986202. DOI: 10.1093/haschl/qxad029.

Prototyping the implementation of a suicide prevention protocol in primary care settings using PDSA cycles: a mixed method study.

Minian N, Gayapersad A, Coroiu A, Dragonetti R, Zawertailo L, Zaheer J Front Psychiatry. 2024; 15:1286078.

PMID: 38333892 PMC: 10850298. DOI: 10.3389/fpsyt.2024.1286078.

Treating individuals with suicidal ideation in primary care: Patient-level characteristics associated with follow-up in the Collaborative Care Model.

Candon M, Benjamin Wolk C, Khazanov G, Oslin D, Pieri M, Press M Suicide Life Threat Behav. 2023; 54(1):15-23.

PMID: 37916734 PMC: 10922361. DOI: 10.1111/sltb.13012.

Shared genetic and environmental etiology between substance use disorders and suicidal behavior.

Edwards A, Ohlsson H, Lannoy S, Stephenson M, Crump C, Sundquist J Psychol Med. 2023; 53(6):2380-2388.

PMID: 37310307 PMC: 10264825. DOI: 10.1017/S0033291721004256.

References

Katon W, Unutzer J . Collaborative care models for depression: time to move from evidence to practice. Arch Intern Med. 2006; 166(21):2304-6. DOI: 10.1001/archinte.166.21.2304. View

Turner E, Matthews A, Linardatos E, Tell R, Rosenthal R . Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med. 2008; 358(3):252-60. DOI: 10.1056/NEJMsa065779. View

Bostwick J . A generalist's guide to treating patients with depression with an emphasis on using side effects to tailor antidepressant therapy. Mayo Clin Proc. 2010; 85(6):538-50. PMC: 2878258. DOI: 10.4065/mcp.2009.0565. View

Busch K, Fawcett J, Jacobs D . Clinical correlates of inpatient suicide. J Clin Psychiatry. 2003; 64(1):14-9. DOI: 10.4088/jcp.v64n0105. View

Wittkampf K, Naeije L, Schene A, Huyser J, van Weert H . Diagnostic accuracy of the mood module of the Patient Health Questionnaire: a systematic review. Gen Hosp Psychiatry. 2007; 29(5):388-95. DOI: 10.1016/j.genhosppsych.2007.06.004. View

Simon G . Collaborative care for mood disorders. Curr Opin Psychiatry. 2009; 22(1):37-41. DOI: 10.1097/YCO.0b013e328313e3f0. View

Palmer B, Pankratz V, Bostwick J . The lifetime risk of suicide in schizophrenia: a reexamination. Arch Gen Psychiatry. 2005; 62(3):247-53. DOI: 10.1001/archpsyc.62.3.247. View

Qin P, Nordentoft M, Hoyer E, Agerbo E, Laursen T, Mortensen P . Trends in suicide risk associated with hospitalized psychiatric illness: a case-control study based on Danish longitudinal registers. J Clin Psychiatry. 2006; 67(12):1936-41. DOI: 10.4088/jcp.v67n1214. View

Bostwick J, Pankratz V . Affective disorders and suicide risk: a reexamination. Am J Psychiatry. 2000; 157(12):1925-32. DOI: 10.1176/appi.ajp.157.12.1925. View

10.

Gilbody S, Bower P, Fletcher J, Richards D, Sutton A . Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med. 2006; 166(21):2314-21. DOI: 10.1001/archinte.166.21.2314. View

11.

Takahashi K, Naito H, Morita M, Suga R, Oguma T, Koizumi T . [Suicide prevention for the elderly in Matsunoyama Town, Higashikubiki County, Niigata Prefecture: psychiatric care for elderly depression in the community]. Seishin Shinkeigaku Zasshi. 1998; 100(7):469-85. View

12.

Kirsch I, Deacon B, Huedo-Medina T, Scoboria A, Moore T, Johnson B . Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med. 2008; 5(2):e45. PMC: 2253608. DOI: 10.1371/journal.pmed.0050045. View

13.

Glied S, Herzog K, Frank R . Review: the net benefits of depression management in primary care. Med Care Res Rev. 2010; 67(3):251-74. DOI: 10.1177/1077558709356357. View

14.

. Screening for depression in adults: U.S. preventive services task force recommendation statement. Ann Intern Med. 2009; 151(11):784-92. DOI: 10.7326/0003-4819-151-11-200912010-00006. View

15.

Alexopoulos G, Katz I, Bruce M, Heo M, Ten Have T, Raue P . Remission in depressed geriatric primary care patients: a report from the PROSPECT study. Am J Psychiatry. 2005; 162(4):718-24. PMC: 2803683. DOI: 10.1176/appi.ajp.162.4.718. View

16.

Stuckler D, Basu S, Suhrcke M, Coutts A, Mckee M . The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet. 2009; 374(9686):315-23. DOI: 10.1016/S0140-6736(09)61124-7. View

17.

. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. Ann Intern Med. 2004; 140(7):554-6. DOI: 10.7326/0003-4819-140-7-200404060-00016. View

18.

Haukka J, Arffman M, Partonen T, Sihvo S, Elovainio M, Tiihonen J . Antidepressant use and mortality in Finland: a register-linkage study from a nationwide cohort. Eur J Clin Pharmacol. 2009; 65(7):715-20. DOI: 10.1007/s00228-009-0616-9. View

19.

Oquendo M, Currier D, Mann J . Prospective studies of suicidal behavior in major depressive and bipolar disorders: what is the evidence for predictive risk factors?. Acta Psychiatr Scand. 2006; 114(3):151-8. DOI: 10.1111/j.1600-0447.2006.00829.x. View

20.

Schuckit M . Alcohol-use disorders. Lancet. 2009; 373(9662):492-501. DOI: 10.1016/S0140-6736(09)60009-X. View