Assessment and Management of Suicide Risk in Primary Care
Abstract
Background: Risk assessment and management of suicidal patients is emphasized as a key component of care in specialist mental health services, but these issues are relatively unexplored in primary care services. Aims: To examine risk assessment and management in primary and secondary care in a clinical sample of individuals who were in contact with mental health services and died by suicide. Method: Data collection from clinical proformas, case records, and semistructured face-to-face interviews with general practitioners. Results: Primary and secondary care data were available for 198 of the 336 cases (59%). The overall agreement in the rating of risk between services was poor (overall κ = .127, p = .10). Depression, care setting (after discharge), suicidal ideation at last contact, and a history of self-harm were associated with a rating of higher risk. Suicide prevention policies were available in 25% of primary care practices, and 33% of staff received training in suicide risk assessments. Conclusion: Risk is difficult to predict, but the variation in risk assessment between professional groups may reflect poor communication. Further research is required to understand this. There appears to be a relative lack of suicide risk assessment training in primary care.
References
2009). Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT study. American Journal of Psychiatry, 166, 882–890.
(2010). National confidential inquiry into suicide and homicide by people with mental illness. Annual report July 2010. Retrieved from www.medicine.manchester.ac.uk
(2012). The national confidential inquiry into suicide and homicide by people with mental illness. Annual report: England, Wales, Scotland and Northern Ireland. Retrieved from www.medicine.manchester.ac.uk
(2011). Consultation on preventing suicide in England: A cross-government outcomes strategy to save lives. London, UK: Department of Health.
. (2011). Examining the relationship between risk assessment and risk management in mental health. Journal of Psychiatric and Mental Health Nursing, 18(10), 862–868.
(1993). Factors associated with suicide after parasuicide in young people. BMJ, 306, 1641–1644.
(2004). Quality of morbidity coding in general practice computerised medical records: A systematic review. Family Practice, 21(4), 396–412.
(2000). Evaluating risks. Advances in Psychiatric Treatment, 6, 399–406.
(2005). Predicting the risk of repetition after self-harm: Cohort study. BMJ, 330(7488), 390–395.
(2011). Longer term management of self harm: Summary of NICE guidelines. BMJ, 343(23), 1–3.
(1995). Clinical assessment versus research methods in the assessment of suicidal behavior. American Journal of Psychiatry, 152(11), 1601–1607.
(2011). Practical suicide-risk management for the busy primary care physician. Mayo Clinic Proceedings, 86(8), 792–800.
(1999). Risk assessment and suicide prevention in primary care. Crisis, 20(4), 171–177.
(2005). Comparison of general practitioner records and patient self-report questionnaires for estimation of costs. European Journal of Health Economics, 50, 261–266.
(2013). Assessing risk of suicide or self harm in adults. BMJ, 347, f4572. doi: 10.1136/bmj.f4572
(2011). Self harm: Longer term management. NICE guidelines CG133. Retrieved from www.nice.org.uk/Guidance/CG133
. (2009). Primary care contact prior to suicide in individuals with mental illness. British Journal of General Practice, 59, 826–832.
(2011). The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168, 1266–1277.
(2010). Suicide victims’ last contact with the primary care physician: Report from Slovenia. International Journal of Social Psychiatry, 56(3), 280–287.
(2002). The use of discharge risk assessment tools in general psychiatric services in the UK. Journal of Psychiatric and Mental Health Nursing, 9, 713–724.
(2008). Suicide in juveniles and adolescents in the United Kingdom. Journal of Child Psychiatry and Psychology, 49, 1165–1175.
(2012). Suicide prevention (SUPRE). Retrieved from www.who.int/mental_health/prevention/suicide/suicideprevent/en/
. (
Access content
To read the fulltext, please use one of the options below to sign in or purchase access.- Personal login
- Register for access
- Claim
-
Restore content access
This functionality works only for purchases made as a guest