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Annals of Family Medicine 5:412-418 (2007)
© 2007 Annals of Family Medicine, Inc.
doi: 10.1370/afm.719
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Let’s Not Talk About It: Suicide Inquiry in Primary Care

Mitchell D. Feldman, MD, MPhil1, Peter Franks, MD2, Paul R. Duberstein, PhD3, Steven Vannoy, PhD3, Ronald Epstein, MD4 and Richard L. Kravitz, MD, Msph5

1 Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, Calif
2 Center for Health Services Research in Primary Care and Family and Community Medicine, University of California-Davis, Sacramento, Calif
3 Program in Geriatrics and Neuropsychiatry, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
4 Departments of Family Medicine and Psychiatry and Center to Improve Communication in Health Care, University of Rochester School of Medicine and Dentistry, Rochester, NY
5 Center for Health Services Research in Primary Care and Department of Internal Medicine, University of California-Davis, Sacramento, Calif

CORRESPONDING AUTHOR: Peter Franks, MD, Department of Family and Community Medicine, University of California-Davis, 4860 Y St, Ste 2300, Sacramento, CA 95817, pfranks{at}ucdavis.edu

PURPOSE The purpose of this study was to ascertain physician characteristics associated with exploring suicidality in patients with depressive symptoms and the influence of patient antidepressant requests.

METHODS Primary care physicians were randomly recruited from 4 sites in northern California and Rochester, NY; 152 physicians participated (53%–61% of those approached). Standardized patients portraying 2 conditions (major depression and adjustment disorder) and 3 antidepressant request types (brand specific, general, or none) made unannounced visits to these physicians between May 2003 and May 2004. We examined factors associated with physician exploration of suicidality.

RESULTS Suicide was explored in 36% of 298 encounters. Exploration was more common when the patient portrayed major depression (vs adjustment disorder) (P = .03), with an antidepressant request (vs no request) (P=.02), in academic settings (P <.01), and among physicians with personal experience with depression (P <.01). The random effects logistic model revealed a significant physician variance component with {rho} = 0.57 (95% confidence interval, 0.45–0.68) indicating that there were additional, unspecified physician factors determining the tendency to explore suicide risk. These factors are unrelated to physician specialty (family medicine or internal medicine), sex, communication style, or perceived barriers to or confidence in treating depression.

CONCLUSIONS When seeing patients with depressive symptoms, primary care physicians do not consistently inquire about suicidality. Their inquiries into suicidal thinking may be enhanced through advertising or public service messaging that prompts patients to ask for help. Research is needed to further elucidate physician characteristics associated with the assessment of suicidality.

Key Words: Depression • adjustment disorders • antidepressants • suicide • primary care • office visits • multilevel models • prevention • screening • practice-based research




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TRACK Comments:

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Yes, Let's Talk About It! Suicide Inquiry in Primary Care a Must
Daniel J Reidenberg
Annals of Family Medicine, 3 Oct 2007 [Full text]
Ditto
Michelle Linn-Gust
Annals of Family Medicine, 8 Oct 2007 [Full text]

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