An audit to identify factors affecting response to treatment among depressed patients who have documented suicidal ideation/attempts in a Bedfordshire Community Mental Health Team.
BACKGROUND
in recent years there has been a general move towards treating depressed patients in the community if at all possible. One factor that may reduce the likelihood of discharge from secondary care is suicidality (Butler et al. 2010). The aim of this audit was to identify factors associated with continued suicidality among patients in a CMHT.


METHODS
we searched an anonymised database of patients and identified all those with previously documented suicidal thoughts or attempts. We also noted the presence of factors such as alcohol problems, drug problems, augmentation therapy and 'other risk' factors (e.g. financial problems or homelessness). We then looked at clinical notes to find out whether or not, according to the latest clinic letter, patients were still reporting suicidality. This facilitated comparison of the aforementioned factors between the group of patients in which suicidality was still present (group N) and the group of patients in which suicidality was no longer a feature (group Y).


RESULTS
of the 56 patients with suicidal thoughts or attempts there were 44 in group N (79%) and 12 in group Y (21%). Overall, alcohol problems, drug problems and 'other' risk factors were proportionally more common among group Y than group N, although sometimes the difference was marginal. Conversely, the percentage of patients on augmentation therapy was greater in group N than group Y. When considering individual diagnostic categories the above trends generally stood for the F32 category, although not necessarily for the F33 category.


CONCLUSIONS
the audit provides an insight into the sorts of factors that might influence outcomes among depressed patients. However, there are limitations to the audit such as small sample size and lack of a fixed follow-up period.


CONCLUSIONS
Although the results are suggestive, it is difficult to make firm conclusions about patient outcomes on the basis of this data. The audit provides a useful starting point, especially in considering the treatment of patients within the BECMHT. However, further research on a wider scale is required before more general conclusions can be made about factors influencing response to treatment among depressed patients.
Foundation Programme East Anglian Deanery, UK.
Clare
C
Holt
Mark
M
Agius
Sophie
S
Butler
Rashid
R
Zaman
D000437:Alcoholism / Q000453:epidemiology / Q000523:psychology; D000928:Antidepressive Agents / Q000627:therapeutic use; D003156:Community Mental Health Services; D015897:Comorbidity; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D004359:Drug Therapy, Combination; D004739:England; D006801:Humans; D008485:Medical Audit; D055502:Secondary Prevention; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000523:psychology
D000928:Antidepressive Agents