A brief screening tool for suicidal symptoms in adolescents and young adults in general health settings: reliability and validity data from the Australian National General Practice Youth Suicide Prevention Project.

Using data from a nationwide project on young people in Australia aimed at assessing suicidality in general health settings, we present a brief screening tool for suicidality (the depressive symptom index suicidality subscale). Two thousand eight hundred and fifty-one (15-24 year old) patients presenting to 247 Australian general practitioners between 1996 and 1998 were assessed. In addition to the suicide screen, patients completed the general health questionnaire-12 and the Center for Epidemiological Studies depression scale. Patients' chief complaints were taken from the summary sheets completed by their general practitioners. Using inter-item correlational and factor-analytic techniques, as well as a general approach to construct validity, we show that the measure has favorable reliability and validity characteristics. We also provide results on cut-points that may facilitate its use in clinical and research settings. Because the screen is brief, easy to use, reliable, and valid, we encourage its use to combat the vexing international health problem of suicide.

Training general practitioners to recognise and respond to psychological distress and suicidal ideation in young people.

OBJECTIVE: To determine the effectiveness of a training program for general practitioners in recognising and responding to psychological distress and suicidal ideation in young people. DESIGN AND SETTING: The study, conducted in general practice surgeries in Tasmania, Victoria and Western Australia in 1996 and 1997, used a pre-/posttest design to audit consecutive young patients presenting in the six weeks before and the six weeks after the GPs' participation in the training program. PARTICIPANTS: Consisted of 23 GPs who attended a youth suicide prevention workshop and 423 patients aged 15-24 years who presented to the GPs' surgeries (203 pre-workshop and 220 post-workshop). INTERVENTION: GPs attended a one-day training workshop designed to enhance their ability to recognise, assess and manage young patients at risk of suicide. MAIN OUTCOME MEASURES: Scores on three patient self-report inventories (General Health Questionnaire-12 [GHQ-12], Center for Epidemiological Studies Depression Scale [CES-D] and Depressive Symptom Inventory--Suicidality Subscale [DSI-SS]); a GP-completed form for each patient summarising presenting complaint(s), psychological assessment and proposed management plan. RESULTS: After training, GPs demonstrated increased recognition rates of psychologically distressed patients scoring above the cut-offs of the GHQ-12 (48% increase; odds ratio [OR], 1.748; 95% CI, 0.904-03.381) and CES-D (39.5% increase; OR, 2.067; 95% CI, 1.031-4.143); enquiry about suicidal ideation increased by 32.5% (OR, 1.483; 95% CI, 0.929-2.366); and identification of suicidal patients (determined by DSI-SS score) increased by 130% (OR, 3.949; 95% CI, 1.577-9.888). Training did not lead to any significant change in GPs' patient management strategies. CONCLUSIONS: A one-day training course can significantly enhance GP detection rates of psychological distress and suicidal ideation in young patients, but higher recognition rates do not necessarily lead to changes in patient management.

The relationship between chief complaints, psychological distress, and suicidal ideation in 15-24-year-old patients presenting to general practitioners.

OBJECTIVES: To determine the prevalence of psychological distress and suicidal ideation among patients aged 15-24 years presenting to general practitioners, and the relationship between these variables and patients' chief complaints. DESIGN AND SETTING: Questionnaire survey of young people presenting to Australian general practitioners between 1996 and 1998. PARTICIPANTS: 247 general practitioners who volunteered to participate in a nationwide project aimed at teaching general practitioners to identify and treat suicidal youth; 3242 consecutive 15-24-year-old patients presenting to participating general practitioners during a specified six-week period. MAIN OUTCOME MEASURES: Patients completed three self-administered questionnaires: the General Health Questionnaire-12, the Center for Epidemiological Studies Depression Scale, and the Depressive Symptom Inventory-Suicidality Subscale. Patients' chief complaints were obtained from summary sheets completed by their general practitioners. RESULTS: While only 12% of patients presented with psychological complaints, about 50% percent had clinically significant levels of psychological distress and 22% had clinically significant levels of suicidal ideation. CONCLUSIONS: Despite presenting with primarily medical complaints, almost half of young people presenting to primary care physicians had high levels of psychological distress and almost a quarter had high levels of suicidal ideation.

Psychological distress and suicidal ideation among 15-24-year-olds presenting to general practice: a pilot study.

OBJECTIVES: The study sought to determine: (i) the prevalence rates of psychological distress and suicidal ideation among 15-24-year-old patients presenting to general practice; and (ii) the relationship between patients' presenting complaints and their levels of psychological distress and suicidal ideation. METHOD: This was a pilot study designed to sample patients aged 15-24 years presenting consecutively to general practitioners during a 4-week period. The study was set among five general practices in the western suburbs of Perth, Western Australia. Participants included five general practitioners and 69 patients aged 15-24 years. Main outcome measures were the General Health Questionnaire (GHQ-12), the Centre for Epidemiological Studies Depression Scale (CES-D) and the Depressive Symptom Inventory-Suicidality Subscale (DSI-SS). RESULTS: One-third of patients scored above the cut-off of the GHQ-12, 31.9% above the cut-off of the CES-D and 20.3% above the cut-off of the DSI-SS. The majority of patients (87.5%) presented with medical complaints. Of these, 26.8%, 23.2% and 21.4% scored above the cut-offs of the GHQ-12, CES-D and DSI-SS, respectively. Patients presenting with psychological complaints (12.5%) were significantly more likely to score above the cut-off of the CES-D. CONCLUSIONS: In this pilot study, patients aged 15-24 presenting to five general practices had relatively high levels of psychological distress and suicidal ideation. Of most concern were those presenting with medical complaints and who also had high levels of unreported psychological distress.