title: Assessment and management of suicide risk in primary care.
abstract: BACKGROUND
  Risk assessment and management of suicidal patients is emphasized as a key component of care in specialist mental health services, but these issues are relatively unexplored in primary care services.
  
  
  OBJECTIVE
  To examine risk assessment and management in primary and secondary care in a clinical sample of individuals who were in contact with mental health services and died by suicide.
  
  
  METHODS
  Data collection from clinical proformas, case records, and semistructured face-to-face interviews with general practitioners.
  
  
  RESULTS
  Primary and secondary care data were available for 198 of the 336 cases (59%). The overall agreement in the rating of risk between services was poor (overall κ = .127, p = .10). Depression, care setting (after discharge), suicidal ideation at last contact, and a history of self-harm were associated with a rating of higher risk. Suicide prevention policies were available in 25% of primary care practices, and 33% of staff received training in suicide risk assessments.
  
  
  CONCLUSIONS
  Risk is difficult to predict, but the variation in risk assessment between professional groups may reflect poor communication. Further research is required to understand this. There appears to be a relative lack of suicide risk assessment training in primary care.
authors.affiliation: <location>School of Public Health and Policy, University of Liverpool, UK</location>
authors.forename: Pooja
authors.initials: P
authors.lastname: Saini
authors.affiliation: <location>Centre for Mental Health and Risk, University of Manchester, UK</location>
authors.forename: David
authors.initials: D
authors.lastname: While
authors.affiliation: <location>School of Social Work, University of Central Lancashire, Preston, UK</location>
authors.forename: Khatidja
authors.initials: K
authors.lastname: Chantler
authors.affiliation: <location>Centre for Mental Health and Risk, University of Manchester, UK</location>
authors.forename: Kirsten
authors.initials: K
authors.lastname: Windfuhr
authors.affiliation: <location>Centre for Mental Health and Risk, University of Manchester, UK</location>
authors.forename: Navneet
authors.initials: N
authors.lastname: Kapur
mesh_terms: D000328:Adult; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D063127:Secondary Health Care / Q000379:methods / Q000706:statistics & numerical data; D013405:Suicide / Q000523:psychology; D000092864:Suicide Prevention
keywords: general practitioners; primary care; risk assessment; secondary care; suicide