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Suicidal ideation in primary care

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Abstract

OBJECTIVE: To describe the prevalence and clinical characteristics of primary care patients who report suicidal ideation during the month before their medical visit.

DESIGN: Analysis of a self-administered suicidal ideation screening item using sociodemographic data, treatment history, and clinical data from structured interviews.

SETTING: Three Rhode Island private family practices, a South Carolina family medicine residency, and a California prepaid internal medicine group practice.

PATIEJVTS: Adult primary care patients [N=2,749), 18 to 70 years old, who are able to read and write English, able to complete study forms, and willing to provide informed consent.

RESULTS: Sixty-seven (2.44%) of the patients reported suicidal ideation (“feeling suicidal”) during the past month, and most of these patients (58.2%) received no mental health care during that time. The adjusted risk of suicidal ideation was significantly elevated for patients with self-reported fair or poor physical health (odds ratio [OR] 2.5; 95% confidence interval [CI1 1.5, 4.1), fair to poor emotional health (OR 18.0; 95% CI 8.8, 37.0), marital distress (OR 4.4; 95% CI 2.2, 8.8), and recent mental health-related work loss (OR 6.3; 95% CI 3.7, 10.5). In the California sample, patients with major depression (OR 31.2; 95% CI 12.8, 76.1), generalized anxiety disorder (OR 23.4; 95% CI 8.1, 67.1), and drug abuse or dependence (OR 9.6; 95% CI 2.9, 31.6) were at increased risk of suicidal ideation. The “feeling suicidal” item identified 10 of 12 patients who acknowledged a recent plan to kill themselves.

CONCLUSIONS: In these primary care patients, suicidal ideation is strongly associated with mental disorder and mental health-related functional impairment, and can be detected with a single self-report “feeling suicidal” item.

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Author information

Authors and Affiliations

  1. the Department of Psychiatry, College of Physicians and Surgeons of Columbia University and New York State Psychiatric Institute, USA

    Mark Olfson MD, MPH & Myrna M. Weissman PhD

  2. Cornell University Medical College, New York, NY

    Andrew C. Leon PhD

  3. University of South Florida, Tampa

    David V. Sheehan MD, MBA

  4. Kaiser Permanente, Oakland, Calif

    Leslie Farber PhD

Authors
  1. Mark Olfson MD, MPH
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  2. Myrna M. Weissman PhD
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  3. Andrew C. Leon PhD
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  4. David V. Sheehan MD, MBA
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  5. Leslie Farber PhD
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This research was supported by the Upjohn Company.

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Olfson, M., Weissman, M.M., Leon, A.C. et al. Suicidal ideation in primary care. J Gen Intern Med 11, 447–453 (1996). https://doi.org/10.1007/BF02599038

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