Suicide risk in primary care: identification and management in older adults

Abstract

The National Strategy for Suicide Prevention (2012) has set a goal to reduce suicides by 20% within 5 years. Suicide rates are higher in older adults compared to most other age groups, and the majority of suicide completers have visited their primary care physician in the year before suicide. Primary care is an ideal setting to identify suicide risk and initiate mental health care. We review risk factors for late-life suicide; methods to assess for different levels of suicidality; and recent research developments regarding both effective assessment and management of suicide risk among older primary care patients. We highlight that broader scale screening of suicide risk may be considered in light of findings that suicidality can occur even in the absence of major risk factors like depression. We also highlight collaborative care models targeting suicide risk, and recent innovative interventions that aim to prevent the development of suicidal ideation and suicidal behavior.

FIGURE 1

SUICIDE RISK AS A SPECTRUM: ASSESSMENT AND INTERVENTION STRATEGIES From the educational videotape by Brown EL, Bruce ML, Raue PJ et al. (2004): Depression Recognition and Assessment in Older Homecare Patients Used with permission from Raue PJ, Brown EL, Meyers BS, Schulberg HC, Bruce ML: Does every allusion to possible suicide require the same response? The Journal of Family Practice. 55:7 2006 July, pg 605-12