A study published in the journal Annals of Family Medicine has illustrated the need for improved communication between primary care physicians and their patients. Although suicidal individuals often see a doctor within a year, and in many cases within a month, of committing suicide, physicians do not consistently ask patients with symptoms of depression if they feel suicidal. A team of researchers, led by Dr. Peter Franks of the University of California— Davis, recruited actresses to portray patients with symptoms of depression. In visits with these "patients," physicians began a discussion on suicide less than half of the time.
The study involved 152 physicians from northern California and Rochester, New York who agreed to two unannounced visits from the "patients," who would covertly tape-recording their appointments. Each physician received a visit from one actress playing a middle-aged woman with major depressive disorder and a visit from a second actress playing a middle-aged woman with adjustment disorder with depressed mood. Individuals with either disorder are at risk for suicide. The researchers also looked at the influence of a patient's request for medication, including three request conditions in their study: asking for an antidepressant by name, asking for "medication that might help," and not asking for anything. Overall, physicians broached the subject of suicide only 36% of the time. Physicians were more likely to bring up the subject if their patient had depression (42%) as opposed to adjustment disorder (30%), and patients requesting medication were also more likely to hear a discussion on suicide. When patients asked for medication, whether they asked for a specific brand or simply asked for something that could help, their physician asked them if they had suicidal thoughts or tendencies 41% of the time, whereas patients not requesting medication received the same potentially life-saving conversation only 27% of the time.
The researchers emphasize that physician's individual traits, attitudes, and personal experiences are also involved in patient assessment and influence whether or not they bring up the topic of suicide with a patient. However, the researchers also surmise that in some instances, physicians may avoid a discussion on suicide with their patients because they believe they feel uncomfortable talking about the subject or mistakenly believe that talking about a suicidal individual’s thoughts will make them more likely to act on those thoughts.
The study has some potential drawbacks, notably that the researchers used only middle-aged women as patients. The risk for suicide varies by age and gender, and the researchers chose to use middle-aged women because data has shown a peak in suicide among this group. Further research would be useful in determining how the age and gender of a patient affects a physician's assessment of them. Focusing on older adults may be especially important, as this group accounts for the most suicides each year, and older adults are also highly likely to see a physician shortly before committing suicide.
Physicians will see patients who are suicidal, and it is important that they can recognize potential warning signs and open up a conversation with their patients. The researchers behind this study believe that change is needed on both ends of the discussion. They suggest that public service announcements encouraging suicidal individuals to talk to their doctors may help more patients to openly ask their physicians for help. And with continued training on how to respond to a suicidal patient, physicians may be better equipped to take appropriate actions and prevent tragedy.
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