Bocquier Aurélie, Pambrun Elodie, Dumesnil Hélène, Villani Patrick, Verdoux Hélène, Verger Pierre
INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), Marseille, France ; Aix Marseille University, UMR_S912, IRD, Marseille, France ; ORS PACA, Southeastern Health Regional Observatory, Marseille, France.
PLoS One. 2013 Dec 10;8(12):e80797. doi: 10.1371/journal.pone.0080797. eCollection 2013.
General practitioners (GPs) have a key role to play in suicide prevention, but the rates at which they question patients with depression about suicidal thoughts and plans are rather low. Little is known about GPs' characteristics associated with such inquiries. Our objectives were to describe GPs' attitudes, perceived barriers, and self-reported practices in this questioning of these patients and to analyze factors associated with these practices.
This cross-sectional survey was conducted among participants in a panel of randomly selected French GPs (1249/1431 participated: 87.3%). GPs were interviewed with a standardized questionnaire covering their professional and personal characteristics, attitudes, and practices in exploring the suicide risk of their patients with depression. We built a suicide inquiry score by summing the responses to 5 items and used a multiple linear regression analysis to explore the characteristics associated with this score.
Most GPs reported inquiring about the presence of suicidal ideation often or very often; less than 30% reported that they frequently explored signs of a specific suicide plan. The mean suicide inquiry score was 12.4 (SD, 2.9; range, 5-20). False ideas, such as thinking that patients who report suicidal ideas do not often commit suicide, were frequent (42.3%). Previous continuing medical education on suicide, participation in a formal mental health network, and patients who committed suicide in the past 5 years were associated with a higher score. Reluctance to question patients about suicide and perception of insufficient skill were associated with a lower score.
CONCLUSIONS/SIGNIFICANCE: This study showed great variability in French GPs' practices in exploring suicide risk in patients with depression. Interventions aiming at improving GPs' initial training and continuing medical education in suicide and/or depression, and their collaboration with mental health specialists should be developed, and their impacts assessed.
全科医生在预防自杀方面发挥着关键作用，但他们询问抑郁症患者自杀想法和计划的比例相当低。关于全科医生进行此类询问的相关特征知之甚少。我们的目标是描述全科医生在询问这些患者时的态度、感知到的障碍以及自我报告的行为，并分析与这些行为相关的因素。
这项横断面调查是在一组随机抽取的法国全科医生中进行的（1249/1431名参与：87.3%）。采用标准化问卷对全科医生进行访谈，内容涵盖他们的专业和个人特征、态度以及在探究抑郁症患者自杀风险方面的行为。我们通过对5个项目的回答进行求和来构建自杀询问得分，并使用多元线性回归分析来探究与该得分相关的特征。
大多数全科医生报告经常或非常频繁地询问自杀意念的存在情况；不到30%的人报告他们经常探究具体自杀计划的迹象。自杀询问得分的平均值为12.4（标准差为2.9；范围为5 - 20）。诸如认为报告有自杀想法的患者不常自杀等错误观念很常见（42.3%）。以前接受过关于自杀的继续医学教育、参与正式的心理健康网络以及过去5年中有患者自杀与得分较高相关。不愿询问患者自杀情况以及认为技能不足与得分较低相关。
结论/意义：本研究表明法国全科医生在探究抑郁症患者自杀风险的行为方面存在很大差异。应制定旨在改善全科医生在自杀和/或抑郁症方面的初始培训和继续医学教育，以及他们与心理健康专家合作的干预措施，并评估其影响。
