Training Boosts GP Confidence in Ability to Prevent Suicide

Daniel M. Keller, PhD

March 10, 2014

MUNICH — A short training program for general practitioners (GPs) can help reshape GPs' attitudes about depression and make them more confident in their ability to treat depressive symptoms and suicidal thoughts, new research shows.

A multinational European study led by Evelien Coppens, PhD, of the Policy Research Centre for Welfare, Public Health and Family at the University of Leuven, Belgium, described the Optimizing Suicide Prevention Programs and their Implementation in Europe (OPSI-Europe, at, a collaboration in 11 countries funded by the European Commission to develop an intervention strategy for the prevention of suicide.

This multilevel, evidence-based program has been implemented in 4 European regions and has been evaluated using a pre-post design to assess its effectiveness. It focuses on a general public awareness campaign, training of community facilitators such as priests and pharmacists, and training of GPs.

Dr. Coppens said that many patients had contact with their GPs in the month before attempting suicide, and many with suicidal ideation often contact their GPs rather than a mental health professional.

"GPs are well placed as the gatekeeper for depression and suicidal ideation. However, they're not always well prepared to do so," Dr. Coppens told delegates attending the 22nd European Congress of Psychiatry (EPA).

"So training programs aiming to increase the GPs' capacity are considered as a useful strategy for suicide prevention," he added.

Detect, Diagnose, Treat

Training designed to improve their ability to detect, diagnose, and treat depressive disorders and to handle acute suicidality was provided to GPs in Ireland (n = 7), Germany (n = 83), Hungary (n = 54), and Portugal (n = 68) ― countries with different health systems and sociocultural characteristics.

Senior GPs delivered the training, lasting 3 to 4 hours, to groups of 12 to 14 attendees. It consisted of a theoretical part and a practical component involving role play and discussions.

Participants were asked to fill out 3 questionnaires before the training, right after, and 3 months later. The Depression Attitude Questionnaire (DAQ) assessed knowledge and attitudes toward the causes, consequences, and treatment of depression.

The Attitudes towards Suicide Prevention scale (ASP) measured attitudes, and the Morriss Confidence Scale (MCS) gauged respondents' confidence in dealing with depression and suicide. Response rates were 93% immediately after training and 54% at 3-month follow-up.

The rather low baseline score on the DAQ indicated that practitioners had relatively little knowledge and some negative attitudes about the causes, consequences, and treatment of depression.

But the relatively high score on the APS indicated relatively positive attitudes toward suicide prevention. The low MCS score at baseline reflected practitioners' lack of confidence in dealing with depression and suicidality.

Table. Training Effects for General Practitioners

Questionnaire Before Training After Training (P-value vs Before) 3-Month Follow-up (P-value vs Before)
DAQ 63/100 66/100 (<.001) 64.5/100 (NS)
ASP 50/70 52/70 (<.001) 50/70 (NS)
MCS 21/40 25/40 (<.001) 25/40 (<.01)

DAQ, Depression Attitude Questionnaire; ASP: Attitudes toward Suicide Prevention scale; MCS, Morriss Confidence Scale; NS: not significant.


Except for results on the ASP, there were differences in scores among the countries immediately after training and at 3 months. On the DAQ, Germany, Hungary, and Portugal showed significant immediate training effects, but only in Germany were the effects preserved at 3 months.

Scores on the MCS showed that the training was effective in bolstering the confidence of participants from all 4 locations in dealing with depression and suicidality in the near term, with physicians from Germany showing the most pronounced effect. The effects were preserved at 3 months for all countries except Ireland. However, one should keep in mind that only 7 physicians from Ireland participated, making it difficult or impossible to generalize.

Dr. Coppens concluded that the baseline scores on the questionnaires showed that there was significant room for improvement in knowledge and attitudes about depression, in attitudes toward suicide prevention, and in confidence in dealing with depression and suicide among the GPs.

"After training, the GPs showed a significant improvement on all 3 competencies, so the training appeared effective," Dr. Coppens concluded. But she said the overall drop-off of effectiveness at 3 months suggests that retraining "attending in particular to rehearsing knowledge and attitudes" is necessary after a few months to keep the learned competencies active.

Drop in Suicide Rate

Session chair Homayun Shahpesandy, MD, PhD, consultant psychiatrist at Roseberry Park Hospital of the Tees, Esk and Wear Valleys NHS Foundation Trust in Middlesbrough, United Kingdom, commended the study for addressing the "very, very important topic of suicide prevention and risk management and assessments."

When asked by Medscape Medical News whether she had tracked the actual effectiveness of the training in preventing suicides, Dr. Coppens said, "It is most important to examine whether the suicide rates actually decline, and there are a few studies.... I think there was a study that was conducted in Nuremberg here in Germany that [had] amazingly good findings, and they found that by training the GPs, the suicide rate in the region declined significantly."

However, the main goal of her project was to develop and test the training materials and intervention, and it therefore did not look at the effects on suicide rates.

Dutch psychiatrist Ruud Harbers, MD, said that it is always a problem to train general practitioners because of the very broad scope of their practices. "Today it's a course about suicide and tomorrow about wound healing with diabetes. So, your 3-month follow-up is not too much."

Dr. Coppens agreed that it would be interesting to retest the trainees at 6 or 12 months. Dr. Harbers added that most depressed and suicidal patients see their GP, so the problem is how to reach GPs. Dr. Coppens said that in Belgium, they are trying to incorporate the training in the medical education of all GPs.

Dr. Coppens, Dr. Shahpesandy, and Dr. Harbers report no relevant financial relationships.

22nd European Congress of Psychiatry (EPA). Session FC05. Presented March 3, 2014.


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