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Now what should I do? Primary care physicians’ responses to older adults expressing thoughts of suicide

Now what should I do? Primary care physicians’ responses to older adults expressing thoughts of suicide.
Vannoy, S., Tai-Seale, M., Duberstein, P., Eaton, L., & Cook, M. (2011). Journal of General Internal Medicine, 26(9),1005-1011.

Primary care visits are an important opportunity for detecting and responding to suicide risk among older adults. However, a research project revealed that primary care physicians who recognize suicide risk among older adult patients are often unable to effectively address this risk. The authors of an article reporting on this research suggested that physicians’ failure to develop meaningful treatment plans for older adults at risk for suicide “may reflect a lack of coherent framework for managing suicide risk, insufficient clinical skills, and availability of mental health specialty support….”

The research identified three patterns of conversations about suicide between physicians and patients. The first is the “argumentative pattern” in which physicians attempt to convince the patient that suicide is unnecessary. The authors found that this approach “results in mutual fatigue and discouragement.” A second response was the “superficial pattern” in which the physician addresses suicide risk and emotional difficulties “in a seemingly aimless manner with no clear therapeutic goal.” The third response, which the authors labeled the “insufficient pattern,” is “characterized by the physicians initially addressing the issue of suicide and comorbid mood disorder, and offering some potential courses of action, only to drop the subject precipitously with no clear sense of closure or treatment plan.”

None of these approaches contributed to developing a meaningful strategy to reduce the risk of suicide. The authors suggest that physician education and practice support may help promote the ability of primary care physicians to effectively respond to suicide risk among their older adult patients. This response could include monitoring the patient, structured follow-up, and referral to mental health specialists.

The authors caution that the small sample size used in this study limited their ability to provide definitive information on this issue and probably prevented the identification of all patterns of conversation about suicide between primary care physicians and older adult patients. The research involved the analysis of videotapes from 385 primary care office visits by patients over the age of 65. Mental health issues were discussed in 84 of these visits and suicide was discussed in six visits. These six visits represented 3 of the 35 physicians involved in the study. Mental health issues were discussed in 22 percent of primary care visits. Conversations about suicide took place in less than 2 percent of all visits.

Resource Note: The Suicide Prevention Toolkit for Rural Primary Care contains information and tools to integrate suicide prevention practices in primary care settings. The toolkit was developed by SPRC in collaboration with the Western Interstate Commission for Higher Education and can be found on the SPRC website at http://www.sprc.org/pctoolkit/index.asp
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