Assessment and Management of Suicide Risk in Primary Care

Abstract

Background: Risk assessment and management of suicidal patients is emphasized as a key component of care in specialist mental health services, but these issues are relatively unexplored in primary care services. Aims: To examine risk assessment and management in primary and secondary care in a clinical sample of individuals who were in contact with mental health services and died by suicide. Method: Data collection from clinical proformas, case records, and semistructured face-to-face interviews with general practitioners. Results: Primary and secondary care data were available for 198 of the 336 cases (59%). The overall agreement in the rating of risk between services was poor (overall κ = .127, p = .10). Depression, care setting (after discharge), suicidal ideation at last contact, and a history of self-harm were associated with a rating of higher risk. Suicide prevention policies were available in 25% of primary care practices, and 33% of staff received training in suicide risk assessments. Conclusion: Risk is difficult to predict, but the variation in risk assessment between professional groups may reflect poor communication. Further research is required to understand this. There appears to be a relative lack of suicide risk assessment training in primary care.

Impact of varying outcomes and definitions of suicidality on the associations of antiepileptic drugs and suicidality: comparisons from UK Clinical Practice Research Datalink (CPRD) and Danish national registries (DNR)

“…This suggests, not surprisingly, that SI is likely to be underreported in general practices. 49,50 Hazard ratios based on the exposure period and the immediate post-exposure period of up to 90 days were broadly similar. This was consistent across AEDs and data sources.…”

“…This proportion was even higher (3.8‐fold, 30 vs 8) when placebo‐exposed patients only were considered. This suggests, not surprisingly, that SI is likely to be underreported in general practices …”

Association between the Density of Physicians and Suicide Rates in Japan: Nationwide Ecological Study Using a Spatial Bayesian Model

“…A study in the United Kingdom pointed out that it was difficult for general practitioners to assess suicide risk in primary care, partly because of a relative lack of suicide risk assessment training [ 31 ]. Non-psychiatrists in Japan are similar to general practitioners in the sense that they have little training in suicide risk assessment.…”

Care Pathways in a Suicide Crisis Assessment Nurse (SCAN) service

“…These challenges increase the complexity of providing care models for suicidal individuals at primary care level. The importance of education at PC level in relation to managing suicidal behaviour has been highlighted previously (Gardner, Dermody, Browne, & Timulak, 2015;Saini, While, Chantler, Windfuhr, & Kapur, 2014), although delivering suicide prevention skills training to General Practitioners (GPs) requires significant resources (Younes et al, 2015), and the implementation of other suicide prevention strategies at PC level can pose major challenges (Audouard-Marzin, Kopp-Bigault, Scouarnec, & Walter, 2019). Improved relationships between PC settings and mental health services when managing self-harm behaviours may help to improve services for managing this complex clinical presentation (Carr et al, 2016).…”