Docs and suicide: "Let's not talk about it"

NEW YORK (Reuters Health) - Primary care physicians do not consistently ask their depressed patients about suicide, according to new research.

"Suicide is a preventable cause of mortality," first author Dr. Mitchell D. Feldman from University of California, San Francisco noted in comments to Reuters Health. "Patients frequently visit their doctor when they are depressed and while they may not feel comfortable initiating a conversation about suicide, they will usually share their thoughts and feelings with their doctor if it is broached in a respectful and sensitive manner."

To see how often doctors confronted with depressed patients bring up the topic of suicide, Feldman and colleagues had trained "patients" portraying depression or adjustment disorder make visits to 152 primary care doctors between May 2003 and May 2004. During some of these visits, they asked for an antidepressant medication.

According to the researchers, the topic of suicide was broached by the physicians in only 36 percent of 298 encounters.

"There is often a window of opportunity for doctors to screen for (suicidal thoughts) and intervene appropriately, but we found they frequently miss this opportunity," Feldman said.

Doctors were more likely to bring up suicide when the patient portrayed depression versus adjustment disorder (42 percent vs 30 percent) and when they asked for an antidepressant medication (41 percent) versus when they did not make such a request (27 percent).

"Patients who make requests get more thorough and appropriate care," Feldman said, "including more inquiries about suicide from their physician."

SOURCE: Annals of Family Medicine, Sept/Oct 2007.