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Improved identification, focus on suicide risk in primary care could reduce mortality

A recent study identified opportunities for suicide prevention and improved identification of mental illness in primary care and medical settings, where most patients receive services prior to death.

However, researchers noted that more training and support may be needed if mental health care providers are to recognize the risk of suicide in order to be able to intervene.

Brian K. Ahmedani, PhD, of the Center for Health Policy and Health Services Research, Henry Ford Health System, and colleagues designed a longitudinal study of the health histories of 5,894 patients who had committed suicide from 2000 to 2010.

The data, spanning a decade, included health insurance claims, diagnosis history and medical and mortality records. Of the patients examined in the study, all were members of health care plans during the year before suicide.

The researchers noted that 83% of patients remained enrolled in a health care plan on a weekly basis during the study period. However, only half of patients who had died by suicide were given a mental health diagnosis resulting from that care. Only 24% of patients had a current mental health diagnosis during the month before the suicide occurred.

Researchers differentiated between ED visits, general practitioner visits and mental health specialist visits in their analysis. In the year preceding suicide, patients attended primary care visits (n=3,780, 64%), specialty visits (n=3,543, 62%) and ED visits (n=2,130, 36%) without receiving a psychiatric diagnosis.

In analysis of services utilized closer to the suicide event, researchers observed that 22% of patients sought any type of medical care in the week before suicide.

“More effort may be needed to train and support providers on the identification of suicide and treatment of mental health,” Ahmedani and colleagues wrote. Previous research found that “a substantial number of primary care physicians would not screen for suicide even if they suspected that a person met criteria for depression.”

According to researchers, mental health care providers may have difficulty assessing suicide risk in patients due to the complex nature of symptoms, a low level of training in dealing specifically with suicide and competing demands on providers.

Despite these precedents, researchers suggested that there is potential for clinicians to intervene on behalf of a suicidal patient. The findings showed that most medical visits relating to suicidal ideation occurred in primary care and medical specialty settings, rather than ED and outpatient settings. Ahmedani and colleagues suggest that “suicide prevention in these clinics would likely reach the largest number of individuals. Greater efforts should be made to assess mental health and suicide risk.”

Disclosure: This study was supported by the National Institute of Mental Health.