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Original Research: Mitchell D. Feldman, Peter Franks, Paul R. Duberstein, Steven Vannoy, Ronald Epstein, and Richard L. Kravitz Let’s Not Talk About It: Suicide Inquiry in Primary Care Ann Fam Med 2007; 5: 412-418 [Abstract] [Full text] [PDF]

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Electronic letters published:

Ditto

Michelle Linn-Gust   (8 October 2007)

Yes, Let's Talk About It! Suicide Inquiry in Primary Care a Must

Daniel J Reidenberg   (3 October 2007)

Ditto 8 October 2007
Michelle Linn-Gust, Albuquerque, USA American Association of Suicidology Survivor Division Director Send response to journal: Re: Ditto	Ditto to Dan's comments. Suicide needs to be where it's instinct to ask. That exploration was more common to physicians who had a personal experience with depression is not enough. Everyone should know to ask and patients should be asking for help. There should be no fear from anyone. Competing interests:   None declared
Yes, Let's Talk About It! Suicide Inquiry in Primary Care a Must 3 October 2007
Daniel J Reidenberg, Bloomington, USA Executive Director-Suicide Awareness Voices of Education Send response to journal: Re: Yes, Let's Talk About It! Suicide Inquiry in Primary Care a Must	Congratulations to the authors of this important study! Daily hearing from people that their physician never asked them about their mental health, let alone the possibility of being suicidal, this study yields important findings that all in the medical field should pay close attention to. We must do better training of physicians and require continuing education on depression and suicide. We must educate the public on the symptoms of depression and raise awareness of the warning signs of suicide. At the same time efforts must be continued to destigmatize mental illnesses and suicide so that it can be talked about by medical professionals and the general public without fear of humiliation, loss of their job or insurance. Patients must feel comfortable coming in to their doctor and saying “I have been depressed lately.” Equally so we need primary care doctors to routinely inquire about patient’s mood which can be symptomatic of an illness in the brain. Depression, bipolar disorder and other illnesses that underlie 90% of all suicides are medical disorders just like cancer, heart disease, diabetes, etc. Too often because these illnesses result in behavioral symptoms people feel characterologically or morally flawed and therefore as patients complain of stomachaches, headaches and back pain due to shame and stigma. However, we know from listening to suicide attempt survivors that if their doctors had just asked about a mental health problem, many would not have made their attempt. While physician disclosure about personal experience with depression likely will help many patients, the primary need is that a physician care enough to ask. By and large showing care, concern, and understanding that mental pain and anguish can be just as painful as the worst cluster migraine or kidney stone is generally enough to start a conversation. Much is known today about the risk factors that place a patient at greater risk of suicide and research has led us to a greater understanding of protective factors that appear to prevent someone from taking their life. (See SAMHSA supported www.sprc.org for this information.) In addition screening devices and lists of warning signs can be easily learned by physicians. While it is impossible to prevent all suicides, clearly this study suggests that with the right information, resources and time, physicians can play a critical role in preventing suicide and the tragic consequences it has on those left behind. Thank you to the authors for their courage to talk about suicide. Competing interests:   None declared