Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-25T06:58:58.422Z Has data issue: false hasContentIssue false
  • English
  • Français

General Practitioners’ experience of child and adolescent suicidal ideation and behaviour – a survey

Published online by Cambridge University Press:  02 November 2015

E. M. Kolshus ,
E. H. Kolshus ,
B. Gavin ,
W. Cullen  and
F. McNicholas
E. M. Kolshus*
Affiliation:
Roscrea Centre Surgery, Roscrea, Co. Tipperary, Ireland
E. H. Kolshus
Affiliation:
Department of Old Age Psychiatry, University Hospital Limerick
B. Gavin
Affiliation:
The Children’s Mental Health Clinic, Dublin, Ireland
W. Cullen
Affiliation:
UCD School of Medicine and Medical Science, Belfield, Dublin, Ireland
F. McNicholas
Affiliation:
The Lucena Clinic, Rathgar, Dublin, Ireland
*
*Address for correspondence: Dr E. M. Kolshus, Roscrea Centre Surgery, Castle Street, Roscrea, Co. Tipperary, Ireland. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

A major cause of death in Irish men aged 15–24 is suicide and the rates for those aged 15–19 are amongst the highest in Europe. Despite concerns over suicidal ideation or behaviour, little research has been done in the Irish primary care context. We therefore aimed to carry out a study of Irish General Practitioners (GPs)’ experience regarding suicidal ideation or behaviour in children and adolescents.

Methods

The study design was a descriptive, cross-sectional, questionnaire survey. We randomly selected 480 GPs and invited them to participate via post.

Results

In total, 198 GPs replied, representing a response rate of 41% with a sampling error of ±6.8%. In total, 184 of respondents (93%) saw more than 50 children and adolescent patients annually, however, presentations of suicidal ideation and behaviour were relatively rare, with 36% reporting seeing none, 58% seeing between one and five and 6% seeing more than five such presentations annually. In total, 119 (62%) of GPs reported a willingness to prescribe antidepressants for this age group. In total, 66% of GPs felt this was either ‘always’ or ‘usually’ a difficult patient group to manage, and the single most commonly reported difficulty by GPs was access to services [n=48 (33%)].

Conclusions

GPs reported that their management of children and adolescents with suicidal ideation or behaviour is often difficult. GPs play a key liaison role in the area of child and adolescent mental health, but our results indicate that GPs are also involved in the treatment of this patient group. However, ongoing education was not a priority according to GPs themselves.

Keywords

Primary caresuicidal behavioursuicidal ideationsurveyyouth
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 34 , Issue 2 , June 2017 , pp. 89 - 97
Copyright
© College of Psychiatrists of Ireland 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arensman, E, Keeley, H (2012). Defining intent. Psychiatry Professional Spring, 8–9.Google Scholar
Bebbington, PE, Minot, S, Cooper, C, Dennis, M, Meltzer, H, Jenkins, R, Brugha, T (2010). Suicidal ideation, self-harm and attempted suicide: results from the British psychiatric morbidity survey 2000. European Psychiatry 25, 427–431.Google Scholar
Beckinsale, P, Martin, G, Clark, S (2001). Youth suicide issues in general practice. Australian Family Physician 30, 391–394.Google Scholar
Christensen, H, Batterham, PJ, O’dea, B (2014). E-health interventions for suicide prevention. International Journal of Environmental Research Public Health 11, 8193–8212.Google Scholar
Clayton, R, Illback, R (2013). Headstrong, the National Centre for Youth Mental Health. Needs Analysis and Programme Description. National Centre for Youth Mental Health: Dublin, Ireland.Google Scholar
Cook, JV, Dickinson, HO, Eccles, MP (2009). Response rates in postal surveys of healthcare professionals between 1996 and 2005: an observational study. BMC Health Services Research 9, 160.Google Scholar
Copty, M, Whitford, D (2005). Mental health in general practice: assessment of current state and future needs. Irish Journal of Psychological Medicine 22, 83–86.Google Scholar
CSO (2010). Yearly Summary of Vital Statistics. Central Statistics Office: Ireland.Google Scholar
Cunningham, CT, Quan, H, Hemmelgarn, B, Noseworthy, T, Beck, CA, Dixon, E, Samuel, S, Ghali, WA, Sykes, LL, Jette, N (2015). Exploring physician specialist response rates to web-based surveys. BMC Medical Research Methodology 15, 32.Google Scholar
De Leo, D, Heller, TS (2004). Who are the kids who self-harm? An Australian self-report school survey. Medical Journal of Australia 181, 140–144.CrossRefGoogle ScholarPubMed
Evans, E, Hawton, K, Rodham, K, Deeks, J (2005). The prevalence of suicidal phenomena in adolescents: a systematic review of population-based studies. Suicide and Life Threatening Behavior 35, 239–250.CrossRefGoogle ScholarPubMed
Evans, S, Brown, R (1993). Perception of need for child psychiatry services among parents and general practitioners. Health Trends 25, 53–56.Google Scholar
Fitzpatrick, C, Nwanolue-Abayomi, N, Kehoe, A, Devlin, N, Glackin, S, Power, L, Guerin, S (2011). Do we miss depressive disorders and suicidal behaviours in clinical practice? Clinical Child Psychology and Psychiatry 17, 449–458.Google Scholar
Flanigan, T, Mcfarlane, E, Cook, S (2008). Conducting survey research among physicians and other medical professionals – a review of current literature. Proceedings of the Survey Research Methods Section, American Statistical Association 4136–4147.Google Scholar
Fuller-Thomson, E, Hamelin, GP, Granger, SJ (2013). Suicidal ideation in a population-based sample of adolescents: implications for family medicine practice. ISRN Family Medicine 2013, 282378.CrossRefGoogle Scholar
Garralda, ME, Bailey, D (1988). Child and family factors associated with referral to child psychiatrists. British Journal of Psychiatry 153, 81–89.Google Scholar
Gavin, B, Cullen, W, O’donoghue, B, Ascencio-Lane, JC, Bury, G, O’callaghan, E (2005). Schizophrenia in general practice: a national survey of general practitioners in Ireland. Irish Journal of Medical Science 174, 38–42.Google Scholar
Gibbons, RD, Hur, K, Bhaumik, DK, Mann, JJ (2006). The relationship between antidepressant prescription rates and rate of early adolescent suicide. American Journal of Psychiatry 163, 1898–1904.Google Scholar
Gilbert, A, Maheux, B, Frappier, JY, Haley, N (2006). Adolescent care. Part 1: are family physicians caring for adolescents’ mental health? Canadian Family Physician 52, 1440–1441.Google Scholar
Griffin, E, Arensman, E, Corcoran, P, Wall, A, Williamson, E, Perry, IJ (2014). National Registry of Deliberate Self Harm Annual Report 2013. National Suicide Research Foundation: Cork.Google Scholar
Hawton, K, James, A (2005). Suicide and deliberate self harm in young people. BMJ 330, 891–894.Google Scholar
Healy, D, Naqvi, S, Meagher, D, Cullen, W, Dunne, C (2013). Primary care support for youth mental health: a preliminary evidence base for Ireland’s Mid-West. Irish Journal of Medical Science 182, 237–243.Google Scholar
Hetrick, S, Merry, S, Mckenzie, J, Sindahl, P, Proctor, M (2007). Selective serotonin reuptake inhibitors (SSRIs) for depressive disorders in children and adolescents. Cochrane Database of Systematic Reviews 18, CD004851.Google Scholar
Hickie, IB, Davenport, TA, Naismith, SL, Scott, EM, Hadzi-Pavlovic, D, Koschera, A (2001). Treatment of common mental disorders in Australian general practice. Medical Journal of Australia 175 (Suppl.): S25–S30.Google Scholar
Hickie, IB, Fogarty, AS, Davenport, TA, Luscombe, GM, Burns, J (2007). Responding to experiences of young people with common mental health problems attending Australian general practice. Medical Journal of Australia 187, S47–S52.Google Scholar
Horowitz, LM, Ballard, ED, Pao, M (2009). Suicide screening in schools, primary care and emergency departments. Current Opinion in Pediatrics 21, 620–627.Google Scholar
HSE (2011). Third annual child & adolescent mental health service report 2010-2011 (http://www.hse.ie/eng/services/Publications/services/Mentalhealth/camh20102011.html). Accessed 20 November 2014.Google Scholar
Hurley, M, Connor, D, Clarke, M, Kelleher, I, Coughlan, H, Lynch, F, Fitzpatrick, C, Cannon, M (2015). Prevalance of mental disorder among young adults in Ireland: a population based study. Irish Journal of Psychological Medicine 32, 79–91.Google Scholar
Illback, RJ, Bates, T, Hodges, C, Galligan, K, Smith, P, Sanders, D, Dooley, B (2010). Jigsaw: engaging communities in the development and implementation of youth mental health services and supports in the Republic of Ireland. Journal of Mental Health 19, 422–435.CrossRefGoogle ScholarPubMed
Joiner, TE Jr, Pfaff, JJ, Acres, JG (2002). Characteristics of suicidal adolescents and young adults presenting to primary care with non-suicidal (indeed non-psychological) complaints. European Journal of Public Health 12, 177–179.Google Scholar
Klein, JB, Jacobs, RH, Reinecke, MA (2007). Cognitive-behavioral therapy for adolescent depression: a meta-analytic investigation of changes in effect-size estimates. Journal of the American Academy of Child and Adolescent Psychiatry 46, 1403–1413.Google Scholar
Kramer, T, Garralda, ME (1998). Psychiatric disorders in adolescents in primary care. British Journal of Psychiatry 173, 508–513.Google Scholar
Leahy, D, Schaffalitzky, E, Armstrong, C, Bury, G, Cussen-Murphy, P, Davis, R, Dooley, B, Gavin, B, Keane, R, Keenan, E, Latham, L, Meagher, D, Mcgorry, P, Mcnicholas, F, O’connor, R, O’dea, E, O’keane, V, O’toole, TP, Reilly, E, Ryan, P, Sanci, L, Smyth, BP, Cullen, W (2013). Primary care and youth mental health in Ireland: qualitative study in deprived urban areas. BMC Family Practice 14, 194.Google Scholar
Lynch, F, Mills, C, Daly, I, Fitzpatrick, C (2004). Challenging times: a study to detect Irish adolescents at risk of psychiatric disorders and suicidal ideation. Journal of Adolescence 27, 441–451.Google Scholar
Lynch, F, Mills, C, Daly, I, Fitzpatrick, C (2006). Challenging times: prevalence of psychiatric disorders and suicidal behaviours in Irish adolescents. Journal of Adolescence 29, 555–573.Google Scholar
MacKay, M, Vincenten, J (2014). National Action to Address Child Intentional Injury – 2014: European Summary. European Child Safety Alliance: Birmingham.Google Scholar
Malone, KM, Quinlivani, L, Mcguinness, S, Mcnicholas, F, Kelleher, C (2012). Suicide in children over two decades: 1993-2008. Irish medical journal 105, 231–233.Google Scholar
Mauerhofer, A, Berchtold, A, Michaud, PA, Suris, JC (2009). GPs’ role in the detection of psychological problems of young people: a population-based study. British Journal of General Practice 59, e308–e314.Google Scholar
McCarty, CA, Russo, J, Grossman, DC, Katon, W, Rockhill, C, Mccauley, E, Richards, J, Richardson, L (2011). Adolescents with suicidal ideation: health care use and functioning. Academic Pediatrics 11, 422–426.Google Scholar
McKelvey, R, Pfaff, J, Acres, JG (2001). The relationship between chief complaints, psychological distress, and suicidal ideation in 15-24 year old patients presenting to general practitioners. Medical Journal of Australia 175, 550–552.CrossRefGoogle ScholarPubMed
McMahon, EM, Keeley, H, Cannon, M, Arensman, E, Perry, IJ, Clarke, M, Chambers, D, Corcoran, P (2014). The iceberg of suicide and self-harm in Irish adolescents: a population-based study. Social Psychiatry and Psychiatric Epidemiology 49, 1929–1935.Google Scholar
McNeill, YL, Gillies, ML, Wood, SF (2002). Fifteen year olds at risk of parasuicide or suicide: how can we identify them in general practice? Family Practice 19, 461–465.Google Scholar
Merry, SN (2010). Group CBT prevents depression in at-risk adolescents. Evidence Based Mental Health 13, 16.Google Scholar
Murphy, M, Vellinga, A, Walkin, S, Macdermott, M (2012). Termination of pregnancy: attitudes and clinical experiences of Irish GPs and GPs-in-training. European Journal of General Practice 18, 136–142.Google Scholar
NICE (2005). Depression in children and young people CG28. National Institute for Health and Clinical Excellence, London.Google Scholar
Nock, MK, Borges, G, Bromet, EJ, Cha, CB, Kessler, RC, Lee, S (2008). Suicide and suicidal behavior. Epidemiology Reviews 30, 133–154.Google Scholar
O’Keeffe, L, O’Reilly, A, O’Brien, G, Buckley, R, Illback, R (2015). Description and outcome evaluation of JIGSAW: an emergent Irish mental health early intervention programme for young people. Irish Journal of Psychological Medicine 32, 71–77.CrossRefGoogle ScholarPubMed
Ougrin, D, Banarsee, R, Dunn-Toroosian, V, Majeed, A (2011). Suicide survey in a London borough: primary care and public health perspectives. Journal of Public Health (Oxford) 33, 385–391.CrossRefGoogle Scholar
Pearson, JL, Stanley, B, King, CA, Fisher, CB (2001). Intervention research with persons at high risk for suicidality: safety and ethical considerations. Journal of Clinical Psychiatry 62 (Suppl. 25): 17–26.Google Scholar
Reinherz, HZ, Tanner, JL, Berger, SR, Beardslee, WR, Fitzmaurice, GM (2006). Adolescent suicidal ideation as predictive of psychopathology, suicidal behavior, and compromised functioning at age 30. American Journal of Psychiatry 163, 1226–1232.Google Scholar
Rickwood, D, Deane, F, Wilson, C (2007). When and how do young people seek professional help for mental health problems? Medical Journal of Australia 187, S35–S36.CrossRefGoogle Scholar
Robinson, J, Hetrick, S, Cox, G, Bendall, S, Yung, A, Yuen, HP, Templer, K, Pirkis, J (2014). The development of a randomised controlled trial testing the effects of an online intervention among school students at risk of suicide. BMC Psychiatry 14, 155.Google Scholar
Robinson, J, Hetrick, SE, Martin, C (2011). Preventing suicide in young people: systematic review. Australian and New Zealand Journal of Psychiatry 45, 3–26.Google Scholar
Sayal, K, Taylor, E (2004). Detection of child mental health disorders by general practitioners. British Journal of General Practice 54, 348–352.Google Scholar
Sayal, K, Yates, N, Spears, M, Stallard, P (2014). Service use in adolescents at risk of depression and self-harm: prospective longitudinal study. Social Psychiatry and Psychiatric Epidemiology 49, 1231–1240.Google Scholar
Schichor, A, Bernstein, B, King, S (1994). Self-reported depressive symptoms in inner-city adolescents seeking routine health care. Adolescence 29, 379–388.Google Scholar
Shain, BN (2007). Suicide and suicide attempts in adolescents. Pediatrics 120, 669–676.Google Scholar
Silverman, MM, Berman, AL, Sanddal, ND, O’carroll, PW, Joiner, TE (2007). Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 1: background, rationale, and methodology. Suicide and Life Threatening Behavior 37, 248–263.Google Scholar
Simon, AE, Lauber, C, Ludewig, K, Braun-Scharm, H, Umbricht, DS, Swiss Early Psychosis, P (2005). General practitioners and schizophrenia: results from a Swiss survey. British Journal of Psychiatry 187, 274–281.Google Scholar
Skegg, K (2005). Self-harm. Lancet 366, 1471–1483.Google Scholar
Stallard, P, Richardson, T, Velleman, S, Attwood, M (2011). Computerized CBT (think, feel, do) for depression and anxiety in children and adolescents: outcomes and feedback from a pilot randomized controlled trial. Behavioural and Cognitive Psychotherapy 39, 273–284.Google Scholar
Tait, L, Michail, M (2014). Educational interventions for general practitioners to identify and manage depression as a suicide risk factor in young people: a systematic review and meta-analysis protocol. Systematic Reviews 3, 145.Google Scholar
Vasa, RA, Carlino, AR, Pine, DS (2006). Pharmacotherapy of depressed children and adolescents: current issues and potential directions. Biological Psychiatry 59, 1021–1028.Google Scholar
Veit, FC, Sanci, LA, Young, DY, Bowes, G (1995). Adolescent health care: perspectives of Victorian general practitioners. Medical Journal of Australia 163, 16–18.Google Scholar
Wasserman, D, Cheng, Q, Jiang, GX (2005). Global suicide rates among young people aged 15-19. World Psychiatry 4, 114–120.Google Scholar
Watanabe, N, Hunot, V, Omori, IM, Churchill, R, Furukawa, TA (2007). Psychotherapy for depression among children and adolescents: a systematic review. Acta Psychiatrica Scandinavica 116, 84–95.Google Scholar
Webb, M, Burns, J, Collin, P (2008). Providing online support for young people with mental health difficulties: challenges and opportunities explored. Early Intervention in Psychiatry 2, 108–113.Google Scholar
Wilkinson, P (2009). In adolescents with SSRI resistant depression, CBT/combined treatment is most effective in those with comorbid disorders. Evidence Based Mental Health 12, 108.CrossRefGoogle ScholarPubMed
Williams, SB, O’connor, EA, Eder, M, Whitlock, EP (2009). Screening for child and adolescent depression in primary care settings: a systematic evidence review for the US Preventive Services Task Force. Pediatrics 123, e716–e735.CrossRefGoogle ScholarPubMed
Wilson, CJ, Deane, FP, Marshall, KL, Dalley, A (2010). Adolescents’ suicidal thinking and reluctance to consult general medical practitioners. Journal of Youth and Adolescence 39, 343–356.Google Scholar
World Health Organization (2000). Preventing Suicide. A Resource for Primary Care Health Workers. World Health Organization: Geneva.Google Scholar
World Health Organization (2014). Preventing Suicide: A Global Imperative. World Health Organization: Geneva.Google Scholar
Zachrisson, HD, Rodje, K, Mykletun, A (2006). Utilization of health services in relation to mental health problems in adolescents: a population based survey. BMC Public Health 6, 34.Google Scholar