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Recognizing Suicidal Patients in a Primary Care Practice

Am Fam Physician. 2002 Oct 15;66(8):1528.

Suicide is one of the top 10 causes of death in the United States. All health care professionals should be vigilant about recognizing patients in their practices who are at risk for suicide. Many elderly patients, more commonly women, see their primary care physicians within a month before suicide. Knowing the health care habits of various age and gender groups in the period before suicide would help identify potential prevention approaches.

Luoma and associates reviewed 40 studies with information available on rates of health care contacts of persons who committed suicide. They used a detailed literature search of articles related to completed suicide. Contacts with primary care physicians or mental health care providers within one month and one year of suicide were reviewed, and lifelong contacts with mental health care providers were also recorded. Nonfatal suicide behaviors (e.g., attempts, ideation) were not included. Patients were classified according to age and gender.

In persons who completed suicide, the rates of contact with mental health care providers within one month and one year of suicide were about 19 and 32 percent, respectively. During the lifetimes of these persons, any contact with mental health care services had occurred in about 53 percent. Persons 35 years and younger had a lower rate (15 percent) of contact with mental health care services in the past month, while persons 55 years and older had an even lower rate (11 percent). Women of all ages in this population were more likely to have contact with mental health care services than men.

In persons who completed suicide, the rates of contact with primary care physicians within one month and one year of suicide were around 45 and 77 percent, respectively. The contact rate within one month for persons 35 years and younger was lower (23 percent), but the contact rate for persons 55 years and older was significantly higher (58 percent). All of the women in this group were found to have had contact with a primary care physician within one year of suicide, while 78 percent of the men had similar contact.

The authors conclude that contact rates are much higher with primary care physicians than with mental health care providers, especially among women and older persons. These results support the need for primary care physicians to become involved in suicide prevention, especially among older adults and women. Suicide prevention among younger men may need to focus elsewhere because this population is less likely to see any health care provider before suicide.

Luoma JB, et al. Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry. June 2002;159:909–16.


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