Suicide Prevention in Primary Care

Primary care clinicians play an important role in suicide prevention.

This was the topic of discussion at this afternoon’s session presented by Jill Harkavy-Friedman, PhD, who is the vice president of research at the American Foundation for Suicide Prevention and associate professor of Clinical Psychology at Columbia University. 

The session started with a discussion of the role of primary care providers in suicide prevention.

“Forty-five percent of people who died by suicide saw their primary care doctor in the month before their death,” she said. “That is important because it is an opportunity for intervention. Even if we can’t save every single person, it’s an opportunity to identify someone who is at risk and help them to feel better."

Model for Understanding Suicide

“There is never one single cause of suicide, it is a multifactored behavior,” she said. She explained that although current life events are commonly seen as the cause for suicide, it is important to look behind the current event at the biological, psychological, and social and environmental factors at work.

She went on to discuss various contributors to suicidal behavior, including mental and physical health; brain function and inflexible thinking; family history, trauma, abuse, and neglect; traumatic brain injury; life stressors; and access to lethal means.

Protective factors against suicide include resilience and the ability to bounce back from stressors; having social and problem-solving skills; connection and a sense of belonging; social support; willingness to participate in mental health care; and access to mental health care.

Warning Signs

From there, she went on to discuss knowing the difference between not feeling well mentally and having a mental health condition. She stressed the importance of a patient’s behavior and mood, as well as listening to what they say.

Suicide in Primary Care

Integrated care is a key method for addressing suicide risk in primary care.

“We did a study where we showed that just having access to psychiatric and mental health professionals in your office, just a phone call away, can be effective in helping you to provide care to someone that you are concerned about in terms of suicide.”

Integrated care enhances treatment for those with health conditions, allows for early identification of at-risk patients, and improves access to care. When integrated care is not possible, establishing relationships with local psychiatrists, maintaining a contact list of local mental health care providers, and having contact information for local emergency departments that treat patients with suicidal ideation allow you to stay prepared for when a crisis occurs.

She concluded by discussing methods for screening for suicide risk among patients, including asking and listening, as well as interventions to consider when you encounter patients who are considering suicide.

“You are not going to make someone suicidal by asking about it. Most often, they are going to feel relief, because it is something that they have been holding inside and keeping as a secret. If you don’t ask, you may miss the opportunity to save someone’s life.”

Treatment with medications, social support, ability to engage with the assessment process, need for hospitalization, long-term treatment, substance use, and aspirations for the future are all considerations that need to be made during intervention.

—Michael Potts

Reference:

Harkavy-Friedman J. Suicide Prevention in Primary Care. Talk presented at: Practical Updates in Primary Care 2020 Virtual Series; October 9-10, 2020; virtual.