The Article in Brief

Let's Not Talk About It: Suicide Inquiry in Primary Care

Mitchell D. Feldman, MD, MPhil, and colleagues

Background The primary care setting presents an excellent opportunity for detecting and addressing suicide risk. This study examines whether characteristics of doctors, patient symptoms, or patient behavior influence whether doctors explore the topic of suicide with their patients.

What This Study Found Primary care doctors do not consistently ask patients about suicide. Among 152 doctors who saw patient actors portraying depression symptoms, suicide was explored in 36 percent of visits. Doctors were more likely to explore the possibility of suicide when the patient actors portrayed major depression (compared with adjustment disorder) and when they asked for antidepressant medication, especially when the medication request was general (as opposed to requesting a particular brand). Exploration of suicide was also more common in academic primary care offices and among doctors who had personal experience with depression (whether in themselves, family members, or close friends).

Implications

• The authors suggest developing advertising or public service messages that encourage patients to ask for help in treating depression without encouraging them to request specific antidepressant medications.
• Research is needed to further explore the characteristics of doctors, patients, and health care settings and the relationships of these characteristics to assessing and reporting suicidal thinking in patients.