Determinants of early identification of suicidal ideation in patients treated with antidepressants or anxiolytics in general practice: a multilevel analysis.
BACKGROUND
General practitioners (GPs) play a key role in identifying and managing patients with suicidal tendencies. Few studies, however, examine both GP and patient characteristics and GP practices associated with suicide assessment. This article aims to evaluate 1) GPs' success in early identification of suicidal ideation (SI) in patients starting antidepressant or anxiolytic treatment, and 2) patient- and GP-related factors associated with this success.


METHODS
Survey of 144 GPs practising in southeastern France and of consecutive adults consulting them during June-October 2004 and prescribed antidepressant or anxiolytic treatment. Data were collected from GPs (consultation-questionnaires focusing on their prescription, diagnosis and detection of SI) and patients (self-administered questionnaires including the Hospital Anxiety and Depression scale and social and demographic characteristics). We used multilevel logistic regression to analyse factors associated with SI detection.


RESULTS
GPs completed consultation-questionnaires for 713 patients, 405 of whom completed self-administered questionnaires. Eighty-nine patients (22%) reported SI; in 43 cases (48%) SI had not been detected by the GP. GPs detected SI more frequently when they had completed continuing medical education about depression, when patients had higher depressive symptom scores, and when consultations were relatively long.


CONCLUSIONS
Study limited to patients receiving initial prescriptions for antidepressants or anxiolytics.


CONCLUSIONS
The percentage of undetected SI in this study population was high. Additional training of GPs increases the chances of detecting SI. Medical training and continuing medical education should include better instruction about SI risk factors and diagnosis, including non-major depressions, and stress that screening requires sufficient consultation time.
Verger
Pierre
P
Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseilles, France. verger@marseille.inserm.fr
Brabis
Pierre-Alexis
PA
Kovess
Viviane
V
Lovell
Anne
A
Sebbah
Remy
R
Villani
Patrick
P
Paraponaris
Alain
A
Rouillon
Frédéric
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D003479:Curriculum; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D042241:Early Diagnosis; D004502:Education, Medical, Continuing; D005194:Family Practice / Q000193:education; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010552:Personality Assessment; D010555:Personality Inventory; D012017:Referral and Consultation; D012307:Risk Factors; D013405:Suicide / Q000523:psychology; D000092864:Suicide Prevention
D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents