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Primary Care and Suicide Prevention

To the Editor: On the basis of their review’s finding that 58% of elderly suicide victims had visited a primary care physician in the month before their death, Jason B. Luoma, M.A., et al. (1) concluded that primary care physicians "have the potential to significantly affect suicide rates for older adults’’ (p. 914). However, we must investigate further how competing demands and time limitations, combined with the relative rarity of suicide, affect primary care physicians’ ability to lower suicide rates.

A general practitioner loses a patient to suicide, on average, once every 6.8 years (2). Consider, too, that primary care physicians spend an average of 18 to 22 minutes with each patient (3). MacDonald (4) calculated that if a general practitioner loses one patient to suicide in 8 years, the physician "carried out 51,199 consultations with patients who are not about to kill themselves in those eight years." To further complicate matters, studies indicate a large proportion of suicide victims who visited their primary care physician before their death presented solely with somatic complaints (5, 6) and did not disclose suicidal intent (5), even on the day of their death.

To be sure, addressing patients’ emotional problems, screening for depression, being alert to the somatization of psychiatric ills, probing for potential suicide risk, and making proper referrals to mental health providers are but a few simple ways that primary care physicians can work to prevent suicide. Just how much power, however, primary care physicians do in fact have (or not have) to prevent suicide remains to be determined with further research and understanding of the use of health services before suicide.

References

1. Luoma JB, Martin CE, Pearson JL: Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry 2002; 159:909-916[Abstract/Free Full Text]
2. Matthews K, Milne S, Ashcroft GW: Role of doctors in the prevention of suicide: the final consultation. Br J Gen Pract 1994; 44:345-348[Medline]
3. Mechanic D, McAlpine DD, Rosenthal M: Are patients’ office visits with physicians getting shorter? N Engl J Med 2001; 344:198-204[Abstract/Free Full Text]
4. MacDonald A: "Suicide prevention" by GPs? (letter). Br J Psychiatry 1992; 161:574
5. Isometsä E, Heikkinen ME, Marttunen MJ, Henriksson MM, Aro HM, Lönnqvist JK: The last appointment before suicide: is suicide intent communicated? Am J Psychiatry 1995; 152:919-922[Abstract/Free Full Text]
6. Harwood DM, Hawton K, Hope T, Jacoby R: Suicide in older people: mode of death, demographic factors, and medical contact before death. Int J Geriatr Psychiatry 2000; 15:736-743[CrossRef][Medline]

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