Brief reportDeterminants of early identification of suicidal ideation in patients treated with antidepressants or anxiolytics in general practice: A multilevel analysis
Introduction
General practitioners (GPs) have a key role in identifying and managing patients with suicidal tendency (Gaynes et al., 2004): significant proportions of people in psychological distress consult their GPs rather than mental health professionals (Paykel et al., 2005); half to two thirds of successful suicide completers visited their GP in the weeks or months before their death (Schulberg et al., 2004). Appropriate GP training programs on the diagnosis and treatment of major depressive disorders (MDD), as in Gotland, can reduce population rates of suicide and suicidal behaviour, although these findings are not always replicated (Rutz et al., 1992, Mann et al., 2005).
While there is some controversy about routine primary care screening for suicide risks in the general population (McNamee and Offord, 1994, Gaynes et al., 2004), several authors strongly recommend that physicians should be alert to suicidal ideation (SI: death wishes, consideration or planning of suicide) among patients with MDD or other suicide risk factors (Schulberg et al., 2004). SI, one of the strongest predictors of suicide, is a key factor in identifying suicide risk (Schneider et al., 2001, Gaynes et al., 2004).
Few studies, however, simultaneously examine both GP and patient characteristics and GP practices associated with suicide assessment (Schulberg et al., 2004, Matthews et al., 1994, Isometsa et al., 1995, Williams et al., 1999). Better understanding of the factors associated with GPs' suicide assessment practices may help in designing training programs. This article intends to evaluate 1) GPs' success in early identification of SI in patients for whom they are starting an antidepressant or anxiolytic treatment; and 2) patient- and GP-related characteristics associated with this success.
Section snippets
Population
The 550 members of a representative panel of GPs (Verger et al., 2005) practising in southeastern France were asked in May 2004 to participate in this study, which surveyed consecutive patients aged 18 years or older who consulted them in June–October 2004, whom they started on an antidepressant or anxiolytic, and who agreed in writing to participate. Patients were considered to “start” these drugs if they had had no such treatment during the preceding 6 months.
Instruments and procedure
When we contacted GPs, we
Results
Of the 550 GPs on our panel, 144 (26%) participated. They did not differ from non-participants in age (p = 0.16) or place of practice (rural/urban) (p = 0.98) but were more frequently women (31.9% vs 21.4% of non-participants, p = 0.01). They completed 713 consultation-questionnaires: 439 (61.5%) for patients prescribed antidepressants and 274 (38.5%) anxiolytics (alone). Of the 713 patients, 405 (56.8%) returned their questionnaires. They did not differ in age (p = 0.28), gender (p = 0.50), or
Discussion
Our results confirm previous findings that primary care physicians detect SI relatively infrequently (Matthews et al., 1994, Isometsa et al., 1995, Williams et al., 1999). The association observed between CME training in MDD and SI detection is consistent with previous findings (Pfaff et al., 2001). Although the transversal nature of our study prevents any causal inference, this suggests that the doctors with specific training may actively ask about SI, perhaps because of better confidence in
Acknowledgments
This study received support from the Southeastern France Regional Union of Private Practitioners, (URML-PACA), the Funds for quality insurance of private medical care (FAQSV-URCAM-PACA), the Foundation for Public Health of the MGEN (national teachers' union mutual insurance fund), the Southeastern Regional Direction for Sanitary and Social Affairs (DRASS-PACA), and the 2002 call for proposals of CNRS/MIRE/DREES/INSERM. We thank Jo Ann Cahn for reading the manuscript and improving our English.
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