Confidence of primary care physicians in assessing the suicidality of geriatric patients.

Abstract

This study examined the confidence levels of physicians in assessing the risk of suicide among older adults in clinical settings. Of the 300 physicians who were selected from a population of 4980 family practice, internal medicine, and geriatric physicians in Illinois, 63% responded to the mail survey. Several categorical items inquired about specific assessment and treatment approaches, referral resources used, barriers to meeting the mental health needs of older patients, and sources of training in suicide risk assessment. All the training items (suicide assessment in medical school, residency, and CME courses; rating of medical school training; and insufficient training in geriatric mental health) were significantly (p < 0.01) associated with confidence in assessing suicidality. The overall model consisting of six variables explained 57% of the variation in confidence scores [F (6, 130) = 28.48, p < 0.001]. Three variables accounted for 50% of the explained variance: confidence in diagnosing depression, residency training in the assessment of suicide risk, and assessment of the intentional misuse of medication. Confidence in diagnosing depression (beta = 0.38, p < 0.001) was the strongest predictor. More effective mental health care will require specific preparation in treating geriatric patients through the full spectrum of medical training, including medical school, residency, and CME courses. Improved prevention of elderly suicide hinges on the enhancement of clinical skills in diagnosing and treating geriatric depression.