Suicide prevention in primary health care settings

Potentials of treatment provision for mental disorders in preventing of suicide

The role of improved detection and management of depression in primary health care is one of the central cornerstones of national suicide prevention strategies. Earlier psychological autopsy studies uniformly indicated most suicides with depression to have occurred without the individual having received adequate, or any, treatment (Isometsa, 1994). Findings from representative forensic toxicological studies similarly have found that suicides were rarely positive for any antidepressant when the lethal method was not an antidepressant overdose (Isacsson et al., 2009). Despite remarkable increase in utilization of antidepressants, even recent studies have found the overwhelming majority of suicides to have been untreated. Information on psychotherapy, electroconvulsive therapy, or other treatments is quite limited, but the findings that do exist are similar (Isometsa et al., 1994).

Few studies have specifically examined suicides in primary care settings, generally finding evidence of adequate treatment in primary care even scarcer than among specialist settings. In most countries, because primary care doctors are responsible for treatment provision for the majority of patients with depression, it is clear that their role has been seen as central for suicide prevention. Overall, improving quality of care of primary care depression is in itself important, but whether education and training are the optimal strategy for preventing suicide remains open, and may depend on time and setting. As previously mentioned here, it is possible that the major problem in prevention may often be an unawareness of suicidal histories, ideas, and plans, rather than the fact that mere depression has remained unrecognized (Vuorilehto et al., 2006; Riihimaki et al., 2014). Nevertheless, benefits of screening for suicide risk are quite uncertain (O’Connor et al, AHRQ Task Force, 2013), and in the absence of clear benefit, some national guidelines advise against use of any risk evaluation scales (NICE, 2011).

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