Suicidal behaviour among primary-care patients with depressive disorders

Background. Most national suicide prevention strategies set improved detection and management of depression in primary health care into a central position. However, suicidal behaviour among primary-care patients with depressive disorders has been seldom investigated.Method. In the Vantaa Primary Care Depression Study, a total of 1119 primary-care patients in the City of Vantaa, Finland, aged 20 to 69 years, were screened for depression with the Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire. Depressive disorders were diagnosed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), and the 137 patients with depressive disorder were included in the study. Suicidal behaviour was investigated cross-sectionally and retrospectively in three time-frames: current, current depressive episode, and lifetime. Current suicidal ideation was measured with the Scale for Suicidal Ideation (SSI), and previous ideation and suicide attempts were evaluated based on interviews plus medical and psychiatric records.Results. Within their lifetimes, 37% (51/137) of the patients had seriously considered suicide and 17% (23/137) attempted it. Lifetime suicidal behaviour was independently and strongly predicted by psychiatric treatment history and co-morbid personality disorder, and suicidal behaviour within the current episode was predicted most effectively by severity of depression.Conclusions. Based on these findings and their convergence with studies of completed suicides, prevention of suicidal behaviour in primary care should probably focus more on high-risk subgroups of depressed patients, including those with moderate to severe major depressive disorder, personality disorder or a history of psychiatric care. Recognition of suicidal behaviour should be improved. The complex psychopathology of these patients in primary care needs to be considered in targeting preventive efforts.

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Do characteristics of patients with major depressive disorder differ between primary and psychiatric care?

Psychological Medicine ◽

10.1017/s0033291707000098 ◽

2007 ◽

Vol 37 (6) ◽

pp. 893-904 ◽

Cited By ~ 25

Author(s):

MARIA S. VUORILEHTO ◽

TARJA K. MELARTIN ◽

HEIKKI J. RYTSÄLÄ ◽

ERKKI T. ISOMETSÄ

Keyword(s):

Primary Care ◽

Major Depressive Disorder ◽

Personality Disorder ◽

Depressive Disorder ◽

Psychiatric Care ◽

Major Depressive ◽

Co Morbidity ◽

Axis I ◽

Dsm Iv ◽

Treatment Settings

Background. Despite the need for rational allocation of resources and cooperation between different treatment settings, clinical differences in patients with major depressive disorder (MDD) between primary and psychiatric care remain obscure. We investigated these differences in representative patient populations from primary care versus secondary level psychiatric care in the city of Vantaa, Finland.Method. We compared MDD patients from primary care in the Vantaa Primary Care Depression Study (PC-VDS) (n=79) with psychiatric out-patients (n=223) and in-patients (n=46) in the Vantaa Depression Study (VDS). DSM-IV diagnoses were assigned by the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I in PC-VDS) or Schedules for Clinical Assessment in Neuropsychiatry (SCAN in VDS), and SCID-II interviews. Comparable information was collected on depression severity, Axis I and II co-morbidity, suicidal behaviour, preceding clinical course, and attitudes towards and pathways to treatment.Results. Prevalence of psychotic subtype and severity of depression were highest among in-patients, but otherwise few clinical differences between psychiatric and primary care patients were detected. Suicide attempts, alcohol dependence, and cluster A personality disorder were associated with treatment in psychiatric care, whereas cluster B personality disorder was associated with primary care treatment. Patients' choice of the initial point of contact for current depressive symptoms seemed to be independent of prior clinical history or attitude towards treatment.Conclusions. Severe, suicidal and psychotic depression cluster in psychiatric in-patient settings, as expected. However, MDD patients in primary care or psychiatric out-patient settings may not differ markedly in their clinical characteristics. This apparent blurring of boundaries between treatment settings calls for enhanced cooperation between settings, and clearer and more structured division of labour.

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Incidence and predictors of suicide attempts among primary-care patients with depressive disorders: a 5-year prospective study

Psychological Medicine ◽

10.1017/s0033291713000706 ◽

2013 ◽

Vol 44 (2) ◽

pp. 291-302 ◽

Cited By ~ 21

Author(s):

K. Riihimäki ◽

M. Vuorilehto ◽

T. Melartin ◽

J. Haukka ◽

E. Isometsä

Keyword(s):

Risk Factors ◽

Primary Care ◽

Substance Abuse ◽

Depressive Disorder ◽

Depressive Disorders ◽

Suicide Attempts ◽

Major Depressive ◽

Primary Care Patients ◽

Dsm Iv

BackgroundNo previous study has prospectively investigated incidence and risk factors for suicide attempts among primary care patients with depression.MethodIn the Vantaa Primary Care Depression Study, a stratified random sample of 1119 patients was screened for depression, and Structured Clinical Interviews for DSM-IV used to diagnose Axis I and II disorders. A total of 137 patients were diagnosed with a DSM-IV depressive disorder. Altogether, 82% of patients completed the 5-year follow-up. Information on timing of suicide attempts, plus major depressive episodes (MDEs) and partial or full remission, or periods of substance abuse were examined with life charts. Incidence of suicide attempts and their stable and time-varying risk factors (phases of depression/substance abuse) were investigated using Cox proportional hazard and Poisson regression models.ResultsDuring the follow-up there were 22 discrete suicide attempts by 14/134 (10.4%) patients. The incidence rates were 0, 5.8 and 107 during full or partial remission or MDEs, or 22.2 and 142 per 1000 patient-years during no or active substance abuse, respectively. In Cox models, current MDE (hazard ratio 33.5, 95% confidence interval 3.6–309.7) was the only significant independent risk factor. Primary care doctors were rarely aware of the suicide attempts.ConclusionsOf the primary care patients with depressive disorders, one-tenth attempted suicide in 5 years. However, risk of suicidal acts was almost exclusively confined to MDEs, with or without concurrent active substance abuse. Suicide prevention among primary care patients with depression should focus on active treatment of major depressive disorder and co-morbid substance use, and awareness of suicide risk.

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Suicide Attempts Among Depressed Inpatients with Depressive Disorder in a Malaysian Sample

Crisis ◽

10.1027/0227-5910/a000088 ◽

2011 ◽

Vol 32 (5) ◽

pp. 283-287 ◽

Cited By ~ 14

Author(s):

L. F. Chan ◽

T. Maniam ◽

A. S. Shamsul

Keyword(s):

Risk Factors ◽

Suicidal Ideation ◽

Suicide Attempt ◽

Depressive Disorder ◽

Suicide Attempts ◽

Psychosocial Risk Factors ◽

Psychosocial Risk ◽

Life Event ◽

Axis I ◽

A Current

Background: Depressed inpatients constitute a high-risk population for suicide attempts. Aims: To describe the interactions of clinical and psychosocial risk factors influencing suicide attempts among a Malaysian sample of depressed inpatients. Methods: Seventy-five subjects were diagnosed with a depressive disorder according to the Structured Clinical Interview for DSM-IV Axis I Disorders-Clinical Version (SCID-CV). Data on suicide attempts, suicidal ideation (Scale for Suicidal Ideation, SSI), depression severity (Beck’s Depression Inventory, BDI), recent life-event changes (Social Readjustment Rating Scale, SRRS), sociodemographic and other relevant clinical factors were collected. Results: A third of the subjects presented after a current suicide attempt. Significant factors for a current suicide attempt were race, religion, recent life-event changes, suicidal ideation, and alcohol use disorder. Independent predictive risk factors for a current suicide attempt were Chinese race, recent marital separation, major mortgage or loans, and being newly diagnosed with depression. Any recent change in personal habits was shown to be a protective factor against current suicide attempt. Age and gender were nonsignificant factors. Conclusions: The findings are generally consistent with existing studies and highlight the role of psychosocial risk factors.

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Advances in psychiatric treatment in primary care

Advances in Psychiatric Treatment ◽

10.1192/apt.7.1.1 ◽

2001 ◽

Vol 7 (1) ◽

pp. 1-8 ◽

Cited By ~ 8

Author(s):

Christopher Dowrick

Keyword(s):

Mental Health ◽

Primary Care ◽

National Health Service ◽

Health Service ◽

Health Professionals ◽

Depressive Disorders ◽

Mental Health Problems ◽

Psychiatric Treatment ◽

Mental Illnesses ◽

Breaking Work

Following ground-breaking work by Shepherd et al (1966) and, more recently, Goldberg & Huxley (1992), primary care is now recognised as the arena in which most contact occurs between the National Health Service (NHS) and people with mental health problems. General practitioners (GPs) remain the first, and in many cases the only, health professionals involved in the management of a whole range of conditions, from common anxiety and depressive disorders to severe and enduring mental illnesses.

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Association of adult attachment and suicidal ideation in primary care patients with multiple chronic conditions

Journal of Affective Disorders ◽

10.1016/j.jad.2018.12.029 ◽

2019 ◽

Vol 246 ◽

pp. 121-125 ◽

Cited By ~ 1

Author(s):

Ina-Maria Rückert-Eheberg ◽

Karoline Lukaschek ◽

Katja Brenk-Franz ◽

Bernhard Strauß ◽

Jochen Gensichen

Keyword(s):

Primary Care ◽

Suicidal Ideation ◽

Adult Attachment ◽

Chronic Conditions ◽

Multiple Chronic Conditions ◽

Primary Care Patients

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Health-related Quality of Life of Primary Care Patients with Depressive Disorders

10.26226/morressier.5885d713d462b8028d8910e9 ◽

2017 ◽

Author(s):

Kirsi Riihimäki

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Depressive Disorders ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

Primary Care Patients

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Mediating role of borderline personality disorder traits in the effects of childhood maltreatment on suicidal behaviour among mood disorder patients

European Psychiatry ◽

10.1016/j.eurpsy.2017.03.011 ◽

2017 ◽

Vol 44 ◽

pp. 53-60 ◽

Cited By ~ 8

Author(s):

K.I. Aaltonen ◽

T. Rosenström ◽

I. Baryshnikov ◽

B. Karpov ◽

T. Melartin ◽

...

Keyword(s):

Borderline Personality Disorder ◽

Suicidal Ideation ◽

Personality Disorder ◽

Childhood Maltreatment ◽

Suicidal Behaviour ◽

Suicide Attempts ◽

Borderline Personality ◽

Mediation Effect ◽

Mediation Analyses ◽

Borderline Personality Disorder Traits

AbstractBackground:Substantial evidence supports an association between childhood maltreatment and suicidal behaviour. However, few studies have examined factors mediating this relationship among patients with unipolar or bipolar mood disorders.Methods:Depressive disorder and bipolar disorder (ICD-10-DCR) patients (n = 287) from the Helsinki University Psychiatric Consortium (HUPC) Study were surveyed on self-reported childhood experiences, current depressive symptoms, borderline personality disorder traits, and lifetime suicidal behaviour. Psychiatric records served to complement the information on suicide attempts. We examined by formal mediation analyses whether (1) the effect of childhood maltreatment on suicidal behaviour is mediated through borderline personality disorder traits and (2) the mediation effect differs between lifetime suicidal ideation and lifetime suicide attempts.Results:The impact of childhood maltreatment in multivariate models on either lifetime suicidal ideation or lifetime suicide attempts showed comparable total effects. In formal mediation analyses, borderline personality disorder traits mediated all of the total effect of childhood maltreatment on lifetime suicide attempts, but only one fifth of the total effect on lifetime suicidal ideation. The mediation effect was stronger for lifetime suicide attempts than for lifetime suicidal ideation (P = 0.002) and independent of current depressive symptoms.Conclusions:The mechanisms of the effect of childhood maltreatment on suicidal ideation versus suicide attempts may diverge among psychiatric patients with mood disorders. Borderline personality disorder traits may contribute to these mechanisms, although the influence appears considerably stronger for suicide attempts than for suicidal ideation.

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Primary Care Patients' Reactions to Mental Health Screening

The International Journal of Psychiatry in Medicine ◽

10.2190/8krc-fjlb-ucga-6caq ◽

1996 ◽

Vol 26 (4) ◽

pp. 431-441 ◽

Cited By ~ 10

Author(s):

Mark Zimmerman ◽

David T. Lush ◽

Neil J. Farber ◽

Jon Hartung ◽

Gary Plescia ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Psychiatric Treatment ◽

Primary Care Clinic ◽

Empirical Support ◽

Medical Patients ◽

Care Clinic ◽

History Of ◽

Primary Care Patients ◽

High Level

Objective: The authors examined whether there is empirical support for the notion that medical patients are upset by being asked questions about psychiatric disorders. Method: Six hundred and one patients attending a primary care clinic completed the SCREENER—a newly developed, brief self-administered questionnaire that surveys a broad range of psychopathology. In addition, they completed a second questionnaire that assessed their attitudes toward the SCREENER. Results: We found a high level of acceptance by patients. The questions were judged easy to answer, and they rarely aroused significant negative affect. Fewer than 2 percent of the patients judged the questions difficult to answer, and fewer than 3 percent were “very much” embarrassed, upset, annoyed, or uncomfortable with the questions. Individuals with a history of psychiatric treatment and poorer current mental health reacted more unfavorably to the questionnaire. Conclusions: From the patient's perspective, it is feasible and acceptable to use self-administered questionnaires for routine screening of psychiatric problems in primary care settings.

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The diagnostic status of patients with conspicuous psychiatric morbidity in primary care

Psychological Medicine ◽

10.1017/s0033291700015282 ◽

1984 ◽

Vol 14 (3) ◽

pp. 673-681 ◽

Cited By ~ 49

Author(s):

Patricia R. Casey ◽

S. Dillon ◽

P. J. Tyrer

Keyword(s):

Primary Care ◽

General Practice ◽

Personality Disorder ◽

Mental State ◽

Depressive Disorders ◽

Psychiatric Morbidity ◽

Epidemiological Studies ◽

Detailed Assessment ◽

One Year ◽

Primary Problem

SynopsisA 7% one-year prevalence rate of conspicuous psychiatric morbidity was found in patients attending a single general practice. The nature of the morbidity was examined by a detailed assessment of mental state and personality, using interview schedules administered by a psychiatrist. Depressive disorders were presented by nearly half of the patients. The overall sex incidence of the disorders was equal, but alcohol abuse was more common in males. A personality disorder was present in 33·9% of all patients seen, although it was rarely diagnosed as the primary problem and was linked to the diagnosis of anxiety states, rather than depressive neurosis. These findings are discussed in relation to other epidemiological studies in primary care.

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