Suicidality? Primary Care Docs Often Fail to Ask

By Finn, Robert | Clinical Psychiatry News, May 2008 | Go to article overview

Suicidality? Primary Care Docs Often Fail to Ask


Finn, Robert, Clinical Psychiatry News


SAN FRANCISCO -- In a randomized trial involving actors portraying patients with major depression, internists and family physicians usually failed to ask these patients about suicidality, even when they correctly made the depression diagnosis, Dr. Mitchell D. Feldman said at a meeting on depression research sponsored by the University of California, San Francisco.

These primary care physicians were more likely to ask about suicide when the patient made specific requests for medication, compared with patients who made no such request, said Dr. Feldman of the University of California, San Francisco. Physicians made suicidality inquiries about 46% of the time when depressed "patients" asked about medication but only 33% of the time when the same actors did not mention medication.

"They knew the patient had depression," Dr. Feldman said. "They were appropriately prescribing an antidepressant or referring. And yet, they failed to screen for suicidality." He finds this especially worrisome in light of other studies showing that about half of all people seek some sort of professional help during the month prior to their suicide.

Asking about medication also significantly affected whether the physicians actually issued a prescription. Depressed patients who made a brand-specific request (for Paxil) left the office with a prescription 53% of the time (although not necessarily with that drug), those who made a general request for medication received a prescription 76% of the time, and those who made no request received a prescription for 31% of the time.

The study involved 152 primary care physicians in San Francisco; Sacramento, Calif.; and Rochester, N.Y. Two "standardized patients" --one trained to portray major depression of moderate severity and the other to portray adjustment disorder with depressed mood--made unannounced visits to each preselected physician. Investigators informed the physicians that they would be visited by standardized patients (SPs) over the next several months and that each SP would present with a combination of common symptoms. They were told that the purpose of the study was to "assess social influences on practice and the competing demands of primary care. …

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