Verger Pierre, Brabis Pierre-Alexis, Kovess Viviane, Lovell Anne, Sebbah Remy, Villani Patrick, Paraponaris Alain, Rouillon Frédéric
Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseilles, France.
J Affect Disord. 2007 Apr;99(1-3):253-7. doi: 10.1016/j.jad.2006.09.012. Epub 2006 Oct 3.
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.
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.
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.
Study limited to patients receiving initial prescriptions for antidepressants or anxiolytics.
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.
全科医生（GP）在识别和管理有自杀倾向的患者方面发挥着关键作用。然而，很少有研究同时考察全科医生和患者的特征以及与自杀评估相关的全科医生诊疗行为。本文旨在评估：1）全科医生在开始接受抗抑郁或抗焦虑治疗的患者中早期识别自杀意念（SI）的成功率；2）与该成功率相关的患者及全科医生因素。
对法国东南部的144名全科医生以及在2004年6月至10月期间连续咨询他们并被开具抗抑郁或抗焦虑治疗药物的成年患者进行调查。数据收集自全科医生（聚焦于其处方、诊断和自杀意念检测的咨询问卷）和患者（包括医院焦虑抑郁量表以及社会和人口统计学特征的自填问卷）。我们使用多水平逻辑回归分析与自杀意念检测相关的因素。
全科医生为713名患者完成了咨询问卷，其中405名患者完成了自填问卷。89名患者（22%）报告有自杀意念；在43例（48%）中，全科医生未检测到自杀意念。当全科医生完成了关于抑郁症的继续医学教育、患者抑郁症状得分较高以及咨询时间相对较长时，全科医生更频繁地检测到自杀意念。
研究仅限于接受抗抑郁药或抗焦虑药初始处方的患者。
本研究人群中未被检测到的自杀意念比例较高。对全科医生进行额外培训可增加检测到自杀意念的机会。医学培训和继续医学教育应包括关于自杀意念危险因素和诊断（包括非重度抑郁症）的更好指导，并强调筛查需要足够的咨询时间。
