From Our 2007 Archives

Doctors Often Fail to Spot Suicidal Patients

By Randy Dotinga
HealthDay Reporter

MONDAY, Sept. 24 (HealthDay News) -- Pointing to a disconnect between doctors and some of their neediest patients, a new study suggests that large numbers of physicians fail to spot symptoms that raise suicide risk.

U.S. researchers recruited actresses to act as patients and visit physicians while showing signs of depression or a similar disorder.

Only 36 percent of the doctors asked the "patients" about suicidal thoughts, the team found.

"There is often a window of opportunity for doctors to screen for suicidality and intervene appropriately, but, as we found, they frequently miss this opportunity," said study lead author Dr. Mitchell Feldman, professor of medicine at the University of California at San Francisco.

According to Feldman, an estimated 2 percent to 7 percent of patients who visit primary-care physicians are thinking about suicide. In fact, as many as 75 percent of people who commit suicide visited a primary-care provider in the 30 days before killing themselves, the research shows.

Still, patients at risk of suicide rarely mention the topic directly to physicians, leaving it up to doctors to figure out what's going on.

"Remarkably little is known about the factors that influence whether primary-care physicians broach the topic of suicide with their depressed patients," Feldman said.

In the new study, researchers recruited 152 physicians from northern California and Rochester, N.Y., to take part. All were told they would get unannounced visits by actors portraying patients who would tape-record their conversations.

A total of 18 actresses visited the doctors playing two types of patients -- a person with major depression or a person with an "adjustment disorder," a catch-all term encompassing a variety of mental problems. Some of the "patients" asked for medication.

The findings are published in the September/October issue of the Annals of Family Medicine.

Doctors were more likely to pursue the prospect of suicide if the "patients" said they had major depression or asked for medication. Doctors who had personal experience with depression were three times more likely to look into suicide.

"Most physicians are not adequately trained to diagnose and treat mental and behavioral problems generally, and this problem is magnified with an issue like suicide that may evoke discomfort in some physicians who will then avoid the topic," Feldman said. "Some mistakenly believe that if they inquire about suicide, they will prompt the patient to consider it."

Feldman added: "I describe suicide as another of the Pandora's Box issues -- like domestic violence -- that doctors may avoid broaching for fear that once they bring it up, they will be unable to contain the patient's emotional responses. And, in addition, they will put themselves way behind schedule."

David Rudd, chair of the psychology department at Texas Tech University, agreed with Feldman. Rudd, who's familiar with the study findings, blamed physician inaction on inadequate training, a fear of making things worse, and "anxiety and apprehension about handling suicidal crises."

What to do? Feldman said doctors need better education about suicidal patients, and patients need to know more about depression and feel comfortable asking for help. "We found that patients who make requests get more thorough and appropriate care including more inquiries about suicide from their physician."

Rudd put it this way: "Physicians are the primary access point for the majority of distressed, suicidal patients. This is critical to saving lives."

SOURCES: Mitchell Feldman, M.D., professor, medicine, University of California at San Francisco; and David Rudd, Ph.D., chair, psychology department, Texas Tech University, Lubbock; September/October 2007, Annals of Family Medicine

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