Family physicians and the risk of suicide in the depressed elderly

Background: Depression is the most frequent psychiatric disorder in the eld erly. It is the reason for most suicides in this age group. Method: We perf ormed a representative survey in primary care. Two written case vignettes w ere presented to 170 family physicians in face-to-face interviews which too k place in their practices. The case vignettes described either (Case I) a mildly depressed otherwise healthy old patient or a severely depressed pati ent (Case 2) with somatic comorbidity. Afterwards the interviewers asked st andardized open questions. The physicians were not let into the mental heal th focus of the study. Results: The response rate was 77.6%. Depression was considered for primary or differential diagnosis by 91.2% of the physician s in Case 1 and by 70% in Case 2 (X-2-test; p < 0.01). For further anamnesi s, only 2.4% of the physicians were interested in suicidal ideation of the patient. When directly asked at the end of the interview, 76.9% of the phys icians said they would talk about suicide. Those who would not, thought tha t the patient would communicate suicidal intent himself/herself or they fea red to induce suicide by asking directly. Conclusion: Thinking of suicidali ty and its prevention is not uppermost in the physicians' mind. Therefore, and also with regard to the relatively high rate of depression recognition, we conclude that educational means should not only focus on the recognitio n and screening of depression, but also on the management-'how to talk abou t...'-of complex problems like suicide in the elderly, in order to change s uicide rates. (C) 1999 Elsevier Science B.V. All rights reserved.