December 13, 1994
Media Contact:Marc Kusinitz
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"If physicians ask only people who meet the criteria for major depression
whether they are having suicidal thoughts they are likely to miss two thirds of
their patients who are thinking about suicide."
Researchers at Johns Hopkins have developed a set of four questions to help general physicians identify people at risk for suicide.
Suicide ranks as a leading cause of death in the United States, claiming approximately 30,000 lives each year.
"Research shows that although people considering suicide don't often volunteer that information, many will admit it if they are asked," says Lisa Cooper-Patrick, MI)., M.P.H., an instructor in the Department of Medicine at Johns Hopkins and an author of the study, which appears in the December 14 issue of the Journal of the American Medical Association. Previous studies, she says, indicate that people frequently consult their physicians shortly before attempting suicide.
Typically people considering suicide complain of stress-related physical ailments, and only some of them seem depressed. "If physicians ask only people who meet the criteria for major depression whether they are having suicidal thoughts, they are likely to miss two thirds of their patients who are thinking about suicide," Cooper-Patrick says.
To develop a quick, easy screen any doctor could use to probe patients for suicidal tendencies, Cooper-Patrick and two colleagues at Hopkins, Rosa Crum, M.D" M.H.S. and Daniel Ford, M.D., M.P.H., set out to identify a few critical traits shared by many suicidal people. Their study is based in part on more than 6,000 responses to a survey conducted in the 1980s by the NIMK Cooper-Patrick and her coauthors found that survey respondents who were considering suicide also tended to complain of sleep disturbance, guilt, depressed mood and feelings of hopelessness.
Cooper-Patrick and her colleagues say doctors should ask patients their own version of these four questions: "Have you ever had a period of two weeks or more when you had trouble falling asleep, staying asleep, waking up too early, or sleeping too much? Have you ever had two weeks or more during which you felt sad, blue, depressed or when you lost interest and pleasure in things that you usually cared about or enjoyed? Has there been a period of two weeks or more when you felt worthless, sinful, or guilty? Has there ever been a period of time when you felt that life was hopeless?"
A positive response, say the authors, is a cue for physicians to consider follow-up or mental health consultation. "Psychiatrists know how to get people to open up," says Cooper-Patrick, "but most general physicians don't know what to ask. We want to give generalists a tool that will make it easier for them."
The four questions can be easily adapted for use in patient interviews or intake forms, providing doctors with insight into the psychological side of their patients' physical complaints.
But, as Cooper-Patrick notes, "these questions are designed as a guide for the practicing generalist, not as a substitute for clinical judgment. They're meant to help doctors set the tone of their patient interviews so that they can get important information."
The study was funded by grants from the National Institute of Mental Health (NIMH), the National Institute on Alcohol Abuse and Alcoholism, the Pew Charitable Trust and the Rockefeller Foundations.