Task Force Says Asking All Patients About Suicide Won't Cut Risk
Suicide remains a leading cause of death in the United States, especially among teenagers and young adults. Anything that could reduce the toll would be good.
But asking everyone who goes to the doctor if he is considering suicide isn't the answer, according to a federal panel that evaluated the effectiveness of existing screening tools for suicide. They found there wasn't enough evidence to know whether screening the general public helps or hurts.
That doesn't mean doctors shouldn't be paying attention to suicide, the U.S. Preventive Services Task Force said Monday.
Instead, the panel said that primary care providers need to be paying attention to people with symptoms of depression and other mental illnesses, as well as people who were recently released from a psychiatric hospital or tried to hurt themselves.
"Recent evidence suggests that interventions during these high-risk periods are effective in reducing suicide deaths," the panel concluded. The recommendation was published in Annals of Internal Medicine.
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About 37,000 people die of suicide in the United States each year.
"They're not saying don't assess," says Jilly Harkavy-Friedman, a clinical psychologist and vice president for research at the American Foundation for Suicide Prevention, a grass-roots group with local chapters. "They do make a point of saying it's important to do an assessment if there's any suggestion of risk whatsoever."
Primary care physicians are supposed to screen for depression, and many medical societies, including the American Academy of Pediatrics, tell their members to ask a patient if he is contemplating suicide.
But many primary care doctors don't have much training in mental health and substance abuse and may feel that they don't have counseling services to recommend.
"They feel in a bind because someone is at risk of suicide, but they don't have the staff to reach out to them," says Julie Goldstein Grument, director of prevention and practice for the Suicide Prevention Resource Center.
Training doctors to recognize warning signs and providing access to mental health services can lower suicide rates, Harkavy-Friedman told Shots. But research on that is in its infancy.
"It's really important to understand that asking someone if they're thinking about suicide is not going to make them suicidal," Harkavy-Friedman says. "If anything it's going to make them feel better, because they don't have to go it alone. That's why primary care providers asking about it is an important step, regardless of if they're mandated to ask every single person."
Friends and family members can be lifesavers, Grument says. "If you're concerned about someone, you should always seek to get them help. You should feel comfortable to ask them directly if they're having thoughts of suicide." That may be as simple as saying: "Sometimes people feel so bad that they're thinking about killing themselves. Is that you?"
Still, that doesn't sound easy. The National Suicide Prevention Lifeline (800-273-8255) can help friends and relatives figure out what to say and do, Grument says. That may involve talking to a family doctor or a faith leader, or making an appointment with a mental health clinic.
"And then stick with it," Grument says. "Let them know why you're bringing them in for that appointment or asking about it."