Suicidal ideation in primary care.
OBJECTIVE
To describe the prevalence and clinical characteristics of primary care patients who report suicidal ideation during the month before their medical visit.


METHODS
Analysis of a self-administered suicidal ideation screening item using sociodemographic data, treatment history, and clinical data from structured interviews.


METHODS
Three Rhode Island private family practices, a South Carolina family medicine residency, and a California prepaid internal medicine group practice.


METHODS
Adult primary care patients (N = 2,749), 18 to 70 years old, who are able to read and write English, able to complete study forms, and willing to provide informed consent.


RESULTS
Sixty-seven (2.44%) of the patients reported suicidal ideation ("feeling suicidal") during the past month, and most of those patients (58.2%) received no mental health care during that time. The adjusted risk of suicidal ideation was significantly elevated for patients with self-reported fair or poor physical health (odds ratio [OR] 2.5; 95% confidence interval [CI] 1.5, 4.1), fair to poor emotional health (OR 18.0; 95% CI 8.8, 37.0), marital distress (OR 4.4; 95% CI 2.2, 8.8), and recent mental health-related work loss (OR 6.3; 95% CI 3.7, 10.5). In the California sample, patients with major depression (R 31.2; 95% CI 12.8, 76.1). generalized anxiety disorder (OR 23.4; 95% CI 8.1, 67.1), and drug abuse or dependence (OR 9.6; 95% CI 2.9, 31.6) were at increased risk of suicidal ideation. The "feeling suicidal" item identified 10 of 12 patients who acknowledged a recent plan to kill themselves.


CONCLUSIONS
In these primary care patients, suicidal ideation is strongly associated with mental disorder and mental health-related functional impairment, and can be detected with a single self-report "feeling suicidal" item.
Olfson
M
M
Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA.
Weissman
M M
MM
Leon
A C
AC
Sheehan
D V
DV
Farber
L
L
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D016001:Confidence Intervals; D003625:Data Collection; D003866:Depressive Disorder / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care / Q000639:trends; D012307:Risk Factors; D017678:Sex Distribution; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data