COMMENTARY

Recognizing Suicide Risk Factors in Primary and Psychiatric Care

Larry Culpepper, MD, MPH

Disclosures

October 25, 2010

In This Article

Should You Ask About Suicidal Ideation?

Physicians might be hesitant to inquire about suicidal thoughts, worried that inquiry might lead to suicide attempts. However, this has not been demonstrated. In contrast, patients with such thoughts often seek the opportunity to discuss them, but may not verbalize their concerns without being prompted. The initiation of an office visit might be the only clue of suicidality. Although patients may be reluctant to divulge their intent to commit suicide, if asked, patients with suicidal ideation usually will tell their physicians about such thoughts.[4]

Recognizing the suicidal patient can be a challenge in primary care settings. No studies have demonstrated that screening for suicidality in primary care settings reduces completed suicides or attempts.[5] Depression screening and severity assessment instruments such as the Patient Health Questionnaire (PHQ)-9 and Quick Inventory of Depressive Symptomatology (QIDS) include questions about suicidal ideation ("Thought that you would be better off dead or hurting yourself in some way?") that can trigger further inquiry by the physician. However, because we do not have instruments that adequately predict which patients with suicidal thoughts will attempt suicide, once they are recognized, further inquiry and physician judgment should determine any intervention.

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