Suicidal Ideation and Primary Care Physicians

A study of physician-patient interactions indicated that work needs to be done to improve communication about depression and suicidal ideation.  Primary care physicians discussed depression with only 52 percent of patients who scored positive for depression on a questionnaire (to which the physicians did not have access). Physicians only discussed suicide with 11 percent of depressed patients, although the questionnaires showed that at least 59 percent had experienced suicidal ideation. While male and female patients were equally represented among those reporting suicidal ideation, the overwhelming majority of patients with whom suicide were discussed were women. Physicians were also more likely to discuss suicide with patients who had lower (rather than higher) levels of ideation.

Transcripts of the conversations between patients and physicians revealed that when physicians spoke with patients about suicide, they used language that encouraged patients to deny suicidal ideation. The authors recommended that programs be designed that encourage patients to initiate discussions with their doctors about depression. They also recommended that physicians be taught to initiate conversations about suicidal ideation with depressed patients and to accurately gauge and respond to suicide risk. This article was based on a secondary analysis of data from a study of physician-patient interactions.

SPRC Resource Note

Primary care settings offer important opportunities for detecting and responding to suicide risk. The Suicide Prevention Toolkit for Primary Care Practices helps primary care physicians assess patients’ risk of suicide, plan interventions, and create safety plans. It includes tools for developing partnerships with mental health providers; pocket guides for assessment, intervention, and safety plan development; and tips for billing and gathering state-specific information. The toolkit is equally useful for physicians working in suburban and urban communities.

Vannoy, S., & Robins, L. (2011). Suicide-related discussions with depressed primary care patients in the USA: Gender and quality gaps. A mixed methods analysis. BMJ Open, 1(2), e000198.