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. 2019 Oct;34(10):2075-2082.
doi: 10.1007/s11606-019-05136-x. Epub 2019 Jul 25.

If You Listen, I Will Talk: the Experience of Being Asked About Suicidality During Routine Primary Care

Julie E Richards  1   2 , Sarah D Hohl  3 , Ursula Whiteside  4 , Evette J Ludman  5 , David C Grossman  5   3   6 , Greg E Simon  5   7 , Susan M Shortreed  5 , Amy K Lee  5 , Rebecca Parrish  7 , Mary Shea  5 , Ryan M Caldeiro  7 , Robert B Penfold  5   3 , Emily C Williams  5   3   8
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If You Listen, I Will Talk: the Experience of Being Asked About Suicidality During Routine Primary Care

Julie E Richards et al. J Gen Intern Med. 2019 Oct.

Abstract

Background: Routine population-based screening for depression is an essential part of evolving health care models integrating care for mental health in primary care. Depression instruments often include questions about suicidal thoughts, but how patients experience these questions in primary care is not known and may have implications for accurate identification of patients at risk.

Objectives: To explore the patient experience of routine population-based depression screening/assessment followed, for some, by suicide risk assessment and discussions with providers.

Design: Qualitative, interview-based study.

Participants: Thirty-seven patients from Kaiser Permanente Washington who had recently screened positive for depression on the 2-item Patient Health Questionnaire [PHQ] and completed the full PHQ-9.

Approach: Criterion sampling identified patients who had recently completed the PHQ-9 ninth question which asks about the frequency of thoughts about self-harm. Patients completed semi-structured interviews by phone, which were recorded and transcribed. Directive and conventional content analyses were used to apply knowledge from prior research and elucidate new information from interviews; thematic analysis was used to organize key content overall and across groups based on endorsement of suicide ideation.

Key results: Four main organizing themes emerged from analyses: (1) Participants believed being asked about suicidality was contextually appropriate and valuable, (2) some participants described a mismatch between their lived experience and the PHQ-9 ninth question, (3) suicidality disclosures involved weighing hope for help against fears of negative consequences, and (4) provider relationships and acts of listening and caring facilitated discussions about suicidality.

Conclusions: All participants believed being asked questions about suicidal thoughts was appropriate, though some who disclosed suicidal thoughts described experiencing stigma and sometimes distanced themselves from suicidality. Direct communication with trusted providers, who listened and expressed empathy, bolstered comfort with disclosure. Future research should consider strategies for reducing stigma and encouraging fearless disclosure among primary care patients experiencing suicidality.

Keywords: depression screening; qualitative; suicidal ideation; suicidality; suicide assessment.

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Conflict of interest statement

The authors declare they do not have a financial conflict of interest related to this manuscript.

Figures

Figure 1
Figure 1
Thematic analysis of the patient experience being asked about suicidality in primary care setting.
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Comment in

References

    1. Gerrity M. Evolving Models of Behavioral Health Integration: Evidence Update 2010-2015. Milbank Memorial Fund; 2016.
    1. Siu AL, Bibbins-Domingo K, Grossman DC, et al. Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2016;315(4):380–387. doi: 10.1001/jama.2015.18392. - DOI - PubMed
    1. National Committee for Quality Assurance. Depression Screening and Follow-Up for Adolescents and Adults (DSF). HEDIS 2019 Volume 2: Technical Specifications for Health Plans. Vol 2. Washington, DC: National Committee for Quality Assurance; 2018.
    1. Simon GE, Coleman KJ, Rossom RC, et al. Risk of suicide attempt and suicide death following completion of the Patient Health Questionnaire depression module in community practice. J Clin Psychiatry. 2016;77(2):221–227. doi: 10.4088/JCP.15m09776. - DOI - PMC - PubMed
    1. Simon GE, Rutter CM, Peterson D, et al. Does response on the PHQ-9 Depression Questionnaire predict subsequent suicide attempt or suicide death? Psychiatr Serv. 2013;64(12):1195–1202. doi: 10.1176/appi.ps.201200587. - DOI - PMC - PubMed

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