Background

Suicidality, depression & the role of the GP

Since the 1980s, the number of suicides in Germany has fallen by around half, reaching 9,206 in 2020. However, the number of suicide attempts is estimated by the WHO to be 10-20 times higher. Around 10% of GP patients have suicidal thoughts, with depressive illness being the most important risk factor in the transition from suicidal thoughts to suicide attempts. The suicide rate increases steadily in old age, which is particularly relevant from a GP's point of view, as GP visits also increase significantly in old age.

General practice plays a central role in depression care and therefore also in suicide prevention due to the relationship of trust between GPs and patients. Half of those diagnosed with depression are treated exclusively by general practitioners, and only a fifth are referred to a specialist. The majority of all people with depression receive treatment with GP involvement.

Studies show that around half of all people who commit suicide still had contact with primary care in the four weeks before their death. At the same time, people seeking help report suicidal thoughts to their GP comparatively rarely on their own initiative. The regular active exploration of suicidal tendencies by GPs therefore represents an important opportunity for suicide prevention, as GPs are usually the first and sometimes the only contact persons.

Tools for recognizing suicidality & advantages of the study

However, this important project presents a challenge due to the limited resources available in GP practices. There are hardly any German-language standardized suicidality screening instruments that are easy to use in GP practices due to their small number of questions.

The aim is to design a new, time-efficient short questionnaire - especially for primary care - that takes into account not only suicide risk factors but also the respective protective aspects that prevent those affected from attempting suicide. This also provides the attending physician with direct information on initial prevention options as part of the diagnostic process.

According to the current guidelines for dealing with acute suicidal tendencies in depressed patients, the basis for offering suicidal patients a discussion and relationship is an "open, direct and serious approach to suicidal tendencies". The SuPr-X can be used very well for this purpose.