Training program helps providers spot suicide risk

After undergoing a training program, physicians showed statistically significant improvements in their knowledge of suicide and confidence in treating at-risk patients, according to a recent study.

Suicide, which is one of the leading causes of death in the United States, accounts for about one death every 11 minutes and took the lives of 45,979 Americans in 2020, according to the CDC. An estimated 12.2 million adults in the U.S. seriously thought about suicide in the same year, and 3.2 million planned a suicide attempt.

Most people who die by suicide had contact with the health care system in the year leading up to their deaths, according to Jenn Stuber, PhD, an associate professor of social work at the University of Washington, and colleagues.

“Mental and substance use disorders are leading risk factors for suicide and are among the most common conditions treated in primary care settings,” Stuber and colleagues wrote in Psychiatry Services. “However, in a recent survey of primary care physicians in the United States, only 16% reported that their practice was ‘well prepared’ to treat patients with these conditions.”

Given the need for suicide prevention training, Stuber and colleagues developed and assessed the impact of the All Patients Safe (APS) program in helping providers identify patients at risk for suicide.

The study included 873 health care providers who completed the program between Nov. 8, 2018, and Dec. 30, 2020, and completed pre- and post-training surveys. Of the participants, 26% worked in primary care, 30% identified as “nonwhite” and 66% were women.

The surveys assessed participants’ understanding of and confidence in multiple topics, including thoughts of suicide and medication and firearm storage.

The researchers reported significant improvements in suicide prevention knowledge, attitudes and confidence. The survey item that showed the most improvement was a true or false question that read “More people die by suicide by firearm than all other means combined,” according to Stuber and colleagues. In the pre-training survey, 77% correctly answered true; in the post-training survey, 94% answered correctly.

Participants additionally had a significant improvement in their attitudes regarding suicidal behavior after completing the program, the researchers wrote.

“Of particular interest, two questions assessed professionals’ attitudes about conversing with patients about firearm and medication storage, a key component of suicide prevention,” Stuber and colleagues wrote. “Discomfort with having conversations about these prevention components decreased from before to after completing APS, and, as expected, survey respondents were more comfortable discussing medication storage than firearm storage.”

When it came to firearm storage, 67% of respondents disagreed with the statement, “I might offend my patients if I ask about their firearms storage practices,” in the pre-training survey, and 74% disagreed in the post-training survey. For medication storage, 74% disagreed with a similar statement in the pre-training survey and 83% disagreed in the post-training survey.

For all eight items that measured participants’ confidence in applying suicide prevention skills, the researchers observed “statistically significant post-training improvement.”

“The results suggest that it is possible to provide high-quality training to health care professionals about suicide, which is an important but not sufficient step in the prevention of suicide,” Stuber said in a press release. “It’s also essential to look at systems and policies to ensure there is maximum support for health care professionals to implement the clinical skills they were taught in the training.”

The study comes on the heels of a larger push for the integration of mental health into primary care. A group of national physician organizations recently issued a call to action to integrate behavioral health services into primary care settings, and the Bipartisan Safer Communities Act added a provision allocating $60 million for mental health training among primary care clinicians who treat children and adolescents through HRSA’s Primary Care Training and Enhancement Program, according to a press release from the American Academy of Family Physicians.

References:

• AAFP Family Medicine Advocacy Rounds. https://track.bgov.jmsend.com/w.aspx?j=351374420&m=bb7fdefe6f754d32b5828e5ed6e1951d Accessed Aug. 2, 2022.
• Facts about suicide. https://www.cdc.gov/suicide/facts/index.html. Accessed Aug. 3, 2022.
• Stuber, J, et al. Psychiatr Serv. 2022;doi:10.1176/appi.ps.202100571.
• Suicide prevention training for health care providers a first step in longer-term efficacy. https://www.eurekalert.org/news-releases/959305. Published July 19, 2022. Accessed Aug. 2, 2022.