Article Figures & Data
Tables
- Table 1.
Comparison of Patients Who Reported Recent Suicidal Ideation at Baseline (n = 232) by Trial Condition and Project
By Trial Condition By Project Characteristic Intervention (n = 127) Usual Care (n = 105) MHAP (n = 119) QuEST (n = 113) MHAP = Mental Health Awareness Project; QuEST = Quality Enhancement by Strategic Teaming; mCES-D = modified Center for Epidemiologic Studies-Depression scale; CIDI = World Health Organization Composite International Diagnostic Interview for Primary Care. * Intervention and usual care differ at P <.05. † Measured on a scale of 0–100, where 100 is most severe. ‡ Measured on a scale of 1–4, where 4 is most severe (reported suicide attempt). Social and demographic Age, mean (SD), y 45.9 (12.1) 45.9 (11.5) 49.6 (11.4)* 42.0 (11.0)* Sex, % female 59.1 66.7 50.4* 75.2* Minority status, % minority 20.5 23.8 26.1 17.7 Marital status, % currently married 41.4* 48.6* 40.3 44.3 High school educated, % yes 85.0 86.7 94.1* 77.0* Employment, % employed full or part time 49.6 50.5 49.6 50.4 Health insurance, % with any 88.6 90.5 100.0* 76.1* Annual household income, mean (SD), $ 27,916 (25,835) 38,979 (59,375) 42,081* (44,282) 23,279* (42,877) Clinical Medical comorbidity, mean (SD), No. of total conditions reported 2.36 (1.82) 2.58 (1.88) 2.64 (2.05) 2.27 (1.60) Severity of depression at baseline on mCES-D,† mean (SD) 68.82 (14.31) 66.64 (14.90) 66.2 (14.2) 69.6 (14.8) Mental health care in previous 6 months, % yes 58.3 57.1 60.5 54.9 Severity of suicidal ideation on CIDI,‡ mean (SD) 2.71 (0.77) 2.49 (0.73) 2.59 (0.72) 2.60 (0.81) - Table 2.
Regression Model Examining Patient and Clinician Characteristics, Plan Type, and Intervention Status as Predictors of Detection of Recent Suicidal Ideation at Index Visit
Characteristic* Adjusted OR (95% CI) P Value OR = odds ratio; CI = confidence interval; mCES-D = modified Center for Epidemiologic Studies-Depression scale; CIDI = World Health Organization Composite International Diagnostic Interview for Primary Care; QuEST = Quality Enhancement by Strategic Teaming; MHAP = Mental Health Awareness Project; HMO = health maintenance organization. * In prior analyses, none of the clinician characteristics met the level of significance required for inclusion in this model (P <.20). † When added to the model with the above terms included. Patient: social and demographic Male sex 4.68 (2.24–9.75) <.001 Patient: clinical Severity of depression on mCES-D 1.01 (0.98–1.03) .6909 Severity of suicidal ideation on CIDI 1.55 (1.00–2.40) .0506 Mental health specialty care in previous 6 months 1.43 (0.73–2.80) .2994 Project (QuEST vs MHAP), also plan type (HMO vs mixed payer) 3.12 (2.12–4.59) <.001 Intervention Intervention vs usual care 2.54 (1.31–4.93) .0059 Intervention*project interaction† 1.01 .9920
Additional Files
Supplemental Figures
Figure 1. QuEST CONSORT sample flow; Figure 2. MHAP CONSORT sample flow.
Files in this Data Supplement:
- Supplemental data: Figure 1 - PDF file, 1 page, 64 KB
- Supplemental data: Figure 2 - PDF file, 1 page, 70 KB
The Article in Brief
Improving Detection of Suicidal Ideation Among Depressed Patients in Primary Care
Paul A. Nutting, MD, MSPH , and colleagues
Background Past research suggests that patients often visit their primary care doctors before completing an act of suicide. It is difficult to identify suicidal patients, however, because completed suicide is relatively rare among primary care patients, and patients don�t usually volunteer that they are having suicidal thoughts. This study examines whether two approaches to improving depression care have an effect on identifying and treating patients with suicidal thoughts.
What This Study Found Two different approaches to improving care of depression among primary care patients also improves clinicians� detection of patients with suicidal thoughts. Brief training of primary care clinicians to improve depression care can double the rate at which they initially detect suicidal patients.
Implications
- Future approaches to depression care should include a focus on preventing suicide.
- This focus includes assessing whether patients have suicidal thoughts and their level of risk for suicide, as well as treating potentially suicidal patients or referring them to mental health professionals.
