 |
|
Adolescent Patients—Healthy or Hurting?
Missed Opportunities to Screen for Suicide Risk in the Primary Care Setting
Diane L. Frankenfield, DrPH;
Penelope M. Keyl, PhD ;
Andrea Gielen, ScD;
Lawrence S. Wissow, MD;
Lisa Werthamer, MSW, ScD;
Susan P. Baker, MPH
Arch Pediatr Adolesc Med. 2000;154:162-168.
Context Adolescent suicide rates have increased dramatically in recent decades. Suicide is the third leading cause of mortality among persons aged 10 to 19 years. Several official guidelines recommend screening for suicidal behavior in the primary care setting.
Objectives To determine the prevalence of adolescent suicidal behavior known to primary care providers and to determine the knowledge, attitudes, and practice of primary care physicians in Maryland regarding screening for risk factors for adolescent suicide.
Design Cross-sectional study using mailed survey.
Setting Maryland from May to July 1995.
Participants All pediatrician (n = 816) and family physician (n = 592) members of the state chapter of the American Academy of Pediatrics and the American Academy of Family Physicians, respectively, who were actively providing ambulatory care.
Main Outcome Measures Adolescent suicidal behavior known to primary care providers and predictors of routine screening for risk factors for adolescent suicide.
Results The response rate was 66%. Three hundred twenty-eight physicians (47%) reported that 1 or more adolescent patients attempted suicide in the previous year, but only 158 (23%) either frequently or always screened adolescent patients for suicide risk factors. Significant factors correlating with routine screening for suicide risk factors included frequently or always counseling about the safer storage of firearms in the home (odds ratio [OR], 5.3; 95% confidence interval [CI], 2.8-10.2); agreeing or strongly agreeing that they were sufficiently trained and knew how to screen for risk factors (OR, 3.2; 95% CI, 1.7-6.3); agreeing or strongly agreeing that they had enough time during the well visit to screen for mental health problems (OR, 2.9; 95% CI, 1.6-5.3); frequently or always counseling about child passenger safety (OR, 2.7; 95% CI, 1.6-4.7); spending more than 5 minutes in anticipatory guidance during the well visit (OR, 2.7; 95% CI, 1.5-4.6); practicing in an urban setting (OR, 2.3; 95% CI, 1.2-4.7); agreeing or strongly agreeing that physicians can be effective in preventing adolescent suicide and that what they do during an office visit may help prevent adolescent suicide (OR, 2.0; 95% CI, 1.2-3.4); and female sex (OR, 1.9; 95% CI, 1.1-3.2).
Conclusions Despite the substantial proportion of primary care providers who encountered suicidal adolescent patients, most providers still do not routinely screen their patients for suicidality or associated risk factors. More training is needed and desired by the survey respondents. Patient confidentiality issues must be addressed. Development and widespread use of a short, easily administered, reliable, and valid screening tool are recommended to help busy clinicians obtain more complete information during all visits.
From the Center for Injury Research and Policy (Drs Frankenfield, Keyl, and Gielen and Ms Baker) and the Departments of Health Policy and Management (Drs Gielen and Wissow) and Mental Hygiene (Dr Werthamer), School of Public Health, and the Department of Emergency Medicine, School of Medicine (Dr Gielen), Johns Hopkins University, Baltimore, Md.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Advancing Medical Education Training in Adolescent Health
Fox et al.
Pediatrics 2008;121:1043-1045.
FULL TEXT
The Effects of Data Collection Mode and Disclosure on Adolescent Reporting of Health Behavior
Beebe et al.
Social Science Computer Review 2006;24:476-488.
ABSTRACT
Improving Detection of Suicidal Ideation Among Depressed Patients in Primary Care
Nutting et al.
Ann Fam Med 2005;3:529-536.
ABSTRACT
| FULL TEXT
Demography of Pediatric Primary Care in Europe: Delivery of Care and Training
Katz et al.
Pediatrics 2002;109:788-796.
ABSTRACT
| FULL TEXT
Detecting Suicide Risk in a Pediatric Emergency Department: Development of a Brief Screening Tool
Horowitz et al.
Pediatrics 2001;107:1133-1137.
ABSTRACT
| FULL TEXT
Effects of recent 0.08% legal blood alcohol limits on fatal crash involvement
Hingson et al.
Inj. Prev. 2000;6:109-114.
ABSTRACT
| FULL TEXT
|
