1. Determinants of early identification of suicidal ideation in patients treated with antidepressants or anxiolytics in general practice: a multilevel analysis.: Early identification of suicidal ideation
- Author
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Rémy Sebbah, Pierre Verger, Pierre-Alexis Brabis, Frédéric Rouillon, Alain Paraponaris, Viviane Kovess, Anne M. Lovell, Patrick Villani, ORS PACA, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Fondation de santé publique, MGEN, Centre de Recherche Psychotropes, Santé Mentale, Société (CESAMES), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Médecin généraliste, Clinique des maladies mentales et de l'encéphale (CMME - Service de psychiatrie), Université Paris Descartes - Paris 5 (UPD5)-Hôpital Sainte-Anne, Southeastern France Regional Union of Private Practitioners (URML PACA), Funds for quality insurance of private medical care (FAQSV-URCAM-PACA), Foundation for Public health of the MGEN, Southeastern Regional Direction for Sanitary and Social Affairs (DRASS-PACA), 2002 call for proposals of CNRS/MIRE/DREES/INSERM., and Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU)
- Subjects
Male ,Suicide Prevention ,Personality Inventory ,Continuing medical education ,Poison control ,Personality Assessment ,Hospital Anxiety and Depression Scale ,Suicide prevention ,0302 clinical medicine ,MESH: Risk Factors ,MESH: Early Diagnosis ,Risk Factors ,Suicidal ideation ,030212 general & internal medicine ,Referral and Consultation ,Depression (differential diagnoses) ,MESH: Aged ,MESH: Middle Aged ,MESH: Curriculum ,Middle Aged ,Anxiety Disorders ,Antidepressive Agents ,3. Good health ,Suicide ,Psychiatry and Mental health ,Clinical Psychology ,Education, Medical, Continuing ,Female ,Curriculum ,medicine.symptom ,General practice ,Family Practice ,Adult ,medicine.medical_specialty ,Psychotropic drugs ,Adolescent ,MESH: Depressive Disorder, Major ,Multilevel model ,MESH: Personality Assessment ,MESH: Referral and Consultation ,03 medical and health sciences ,Injury prevention ,medicine ,Humans ,Medical prescription ,Psychiatry ,MESH: Family Practice ,Aged ,MESH: Adolescent ,Depressive Disorder, Major ,MESH: Humans ,business.industry ,MESH: Adult ,MESH: Education, Medical, Continuing ,MESH: Male ,030227 psychiatry ,MESH: Anti-Anxiety Agents ,MESH: Personality Inventory ,MESH: Suicide ,Early Diagnosis ,Anti-Anxiety Agents ,[SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health ,MESH: Anxiety Disorders ,MESH: Antidepressive Agents ,business ,MESH: Female - Abstract
International audience; BACKGROUND: General practitioners (GPs) play a key role in identifying and managing patients with suicidal tendencies. Few studies, however, examine both GP and patient characteristics and GP practices associated with suicide assessment. This article aims to evaluate 1) GPs' success in early identification of suicidal ideation (SI) in patients starting antidepressant or anxiolytic treatment, and 2) patient- and GP-related factors associated with this success. METHODS: Survey of 144 GPs practising in southeastern France and of consecutive adults consulting them during June-October 2004 and prescribed antidepressant or anxiolytic treatment. Data were collected from GPs (consultation-questionnaires focusing on their prescription, diagnosis and detection of SI) and patients (self-administered questionnaires including the Hospital Anxiety and Depression scale and social and demographic characteristics). We used multilevel logistic regression to analyse factors associated with SI detection. RESULTS: GPs completed consultation-questionnaires for 713 patients, 405 of whom completed self-administered questionnaires. Eighty-nine patients (22%) reported SI; in 43 cases (48%) SI had not been detected by the GP. GPs detected SI more frequently when they had completed continuing medical education about depression, when patients had higher depressive symptom scores, and when consultations were relatively long. LIMITATIONS: Study limited to patients receiving initial prescriptions for antidepressants or anxiolytics. CONCLUSIONS: The percentage of undetected SI in this study population was high. Additional training of GPs increases the chances of detecting SI. Medical training and continuing medical education should include better instruction about SI risk factors and diagnosis, including non-major depressions, and stress that screening requires sufficient consultation time.
- Published
- 2007
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