Suicide risk assessment and safety planning in integrated primary care settings: Recommendations for behavioral health consultants

Primary care is an important setting for improving identification and treatment of people at risk for suicide. However, there are few standardized protocols for management of suicide risk in primary care. In this paper, we outline evidence-based practice considerations for behavioral health consultants (BHCs) tasked with conducting suicide risk assessments and safety planning interventions in […]

When health services are powerless to prevent suicide: Results from a linkage study of suicide among men with no service contact in the year prior to death

Aims: To investigate cases of suicide in which there was no healthcare contact, by looking at history of help-seeking and evidence of previous mental health vulnerability. To identify any life events associated with suicide for which individuals did not seek help. Background: Previous research has suggested that non-consultation is the main barrier to suicide prevention among men. […]

Can routine primary care records help in detecting suicide risk? A population-based case-control study in Barcelona

Objectives To characterize people who died by suicide after having previous contacts with public health system using the data available in a primary care setting. Method A retrospective, population-based case-control study identified through autopsy reports subjects who died from suicide between 2010 and 2015 in Barcelona province. Those who had previous interaction with primary healthcare […]

Identifying mental disorders in primary care: Diagnostic accuracy of the Connected Mind Fast check (CMFC) electronic screen

Primary care physicians (PCPs) often daily address diagnoses and treatment of mental disorders in their practices. The current study examined the Connected Mind Fast Check (CMFC), a two-tiered electronic screen, assessing six common mental disorders. The eight-item Initial Screen assesses possible symptoms, whereas SAM modules establish provisional diagnoses and areas of clinical concern. With 234 […]

Adolescent suicide assessment and management in primary care

Background To understand how suicide management occurs within the primary care setting in terms of follow-up assessments and referral practices. Methods At an initial primary care visit, adolescents (aged 12–20 years old) completed electronic screening. Data were focused on youth who endorsed a suicidal risk item while completing screening at two Midwestern primary care clinics. Data […]

Suicide prevention in primary care: The opportunity for intervention

Suicide is a leading cause of death internationally, and self-harm significantly increases the risk of suicide (Hawton et al., 2015; World Health Organization, 2014). To tackle this global health crisis a multisystem, inter-faceted, joined-up approach across health and social care, education, judicial, financial, and voluntary sectors is needed. Within this, the health setting of primary care holds […]

Self-harm risk in pregnancy: Recurrent-event survival analysis using UK primary care data

Background: Perinatal self-harm is of concern but poorly understood. Aims: To determine if women’s risk of self-harm changes in pregnancy and the first postpartum year, and if risk varies by mental illness, age and birth outcome. Method: This was a retrospective cohort study of 2 666 088 women aged 15–45 years from the 1 January […]

Implementing suicide risk screening in a pediatric primary care setting: From research to practice

Objective To describe the methodological development and feasibility of real-world implementation of suicide risk screening into a pediatric primary care setting. Methods A suicide risk screening quality improvement project (QIP) was implemented by medical leadership from a suburban-based pediatric (ages 12–25 years) primary care practice in collaboration with a National Institute of Mental Health (NIMH) […]

The prevalence of suicide prevention training and suicide-related terminology in United States chiropractic training and licensing requirements

Objective: To summarize the prevalence of suicide-related terminology in US doctor of chiropractic educational programs, residency programs, continuing education training, diplomate training programs, and state licensure requirements. The secondary objective was to provide next-step recommendations to enhance suicide prevention education and training for the profession. Methods: A review of public-facing electronic documents and websites occurred from April […]

Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: A population-based cohort study

Background The COVID-19 pandemic has adversely affected population mental health. We aimed to assess temporal trends in primary care-recorded common mental illness, episodes of self-harm, psychotropic medication prescribing, and general practitioner (GP) referrals to mental health services during the COVID-19 emergency in the UK. Methods We did a population-based cohort study using primary care electronic […]

Suicide prevention training: Self-perceived competence among primary healthcare professionals

Objective: The aim is to report the outcomes of the suicide prevention training in terms of the self-perceived impact on the participants. Design: The three-hour training consisted areas of risk and protective factors, screening and evaluating suicide risk, raising concerns and confronting suicidal patients, and treating suicidal ideation in primary healthcare and the associated referral processes. Subjects: The […]

Effects of brief and depression and anxiety management training on a US Army division’s primary care providers

Introduction There is a nation-wide gap between the prevalence of mental illness and the availability of psychiatrists. This places reliance on primary care providers (PCPs) to help meet some of these mental health needs. Similarly, the US Army expects its PCPs to be able to manage common mental illnesses such as anxiety and depression. Therefore, […]

Emerging adults’ attitudes and beliefs about suicide and technology/social media

Suicide in emerging adults (18-29 years) is increasing in the United States, especially amidst coronavirus disease 2019. How the use of technology/social media affects suicidal behaviors is unclear. The purpose of this study was to examine attitudes and beliefs of emerging adults about suicide and identify whether relationships exist with technology/social media use. A total of 297 participants […]

Men and suicide: Primary care prevention in the era of COVID-19 and beyond

The COVID-19 pandemic has had detrimental effects on mental health, including a predicted increase in suicidality, making suicide prevention a high priority. The rate of men’s suicide in the United States is significantly higher than that of women’s suicide. This case study considers the role of primary care advanced practice nurses in addressing the risks […]

Suicide as a hidden contributor to the opioid crisis and the role that primary care and emergency medicine play in addressing it

Deaths from overdose have risen dramatically over the past decade, driven mainly by opioids. In response, the Centers for Disease Control and Prevention released guidance on safe prescribing, safe storage of medications, Medication-Assisted Treatment (MAT), and the use of Naloxone to reverse an overdose. Even with this guidance, overdose deaths continue to rise. Suicide prevention […]

Who didn’t consult the doctor? Understanding sociodemographic factors in relation to health care uptake before suicide

Objective This study aimed to establish differences between suicide decedents and a reference population across various health care settings. Methods This population-wide registration study combined death statistics, sociodemographic data and health care data from Statistics Netherlands. From 2010 to 2016, 12,015 suicide cases and a random reference group of 132,504 were included and assigned to […]

Accuracy requirements for cost-effective suicide risk prediction among primary care patients in the US

Objective: To identify threshold values of sensitivity, specificity, and positive predictive value that a suicide risk prediction method must attain to cost-effectively target a suicide risk reduction intervention to high-risk individuals. Design, setting, and participants: This economic evaluation incorporated published data on suicide epidemiology, the health care and societal costs of suicide, and the costs and efficacy […]

Brief video-based suicide prevention training for primary care

Background and objectives: One-third of individuals who die by suicide had primary care contact in the preceding month. Primary care trainees need engaging and effective suicide prevention training that can be delivered within tight time and resource constraints. However, training is currently scarce and its effectiveness unknown. The objective of this study was to assess learner […]

Mobile texting and lay health supporters to improve schizophrenia care in a resource-poor community in rural China (LEAN Trial): Randomized controlled trial extended implementation

Background: Schizophrenia is a severe and disabling condition that presents a dire health equity challenge. Our initial 6-month trial (previously reported) using mobile texting and lay health supporters, called LEAN, significantly improved medication adherence from 0.48 to 0.61 (adjusted mean 0.11, 95% CI 0.03 to 0.20, P=.007) for adults with schizophrenia living in a resource-poor village in […]

Patient-related factors associated with an increased risk of being a reported case of preventable harm in first-line health care: A case-control study

Background: Patient safety issues in primary health care and in emergency departments have not been as thoroughly explored as patient safety issues in the hospital setting. Knowledge is particularly sparse regarding which patients have a higher risk of harm in these settings. The objective was to evaluate which patient-related factors were associated with risk of harm […]

Asking about self-harm and suicide in primary care: Moral and practical dimensions

Objective Self-harm and suicide are important topics to discuss with people experiencing mental health conditions. This study explores how such discussions unfold in practice, and how their moral and practical repercussions manifest for patients and doctors. Methods Conversation analysis (CA) was used to examine 20 recorded examples of doctors’ questions about self-harm and suicide and […]

Engaging primary care professionals in suicide prevention: A qualitative study

In health systems with strongly developed primary care, such as in the Netherlands, effectively engaging primary care professionals (PCPs) in suicide prevention is a key strategy. As part of the national Suicide Prevention Action Network (SUPRANET), a program was offered to PCPs in six regions in the Netherlands in 2017–2018 to more effectively engage them […]

The feasibility and impact of a suicide risk screening program in rural adult primary care: A pilot test of the Ask suicide-screening questions toolkit

Objective The purpose of this study was to evaluate the feasibility and impact of a suicide risk screening program in a rural West Virginia primary care practice. Methods Patients presenting for routine and sick visits were asked to participate in electronic suicide risk screening using the Ask Suicide-Screening Questions tool; screen positive individuals were assessed […]