Les outils cliniques d’évaluation du risque suicidaire chez l’adulte en médecine générale

Abstract

It is estimated that almost half of suicide victims have consulted a general practitioner during the month preceding their act. The implementation of a suicide risk assessment tool validated in primary care is therefore needed in general medical practice. To review the suicide risk assessment tools for adults, to discuss their validity, and to suggest a pertinent tool which could be used in primary care. Research into scientific databases (keywords: psychiatric status rating scales; tools; questionnaires; risk assessment; suicide; attempted suicide; suicidal ideation; primary care; family practice; general practice) and into French and English language primary care journals. Review of publications and recommendations from health promotion and suicide prevention organizations, and from general practice and psychiatry learned societies. Two categories of suicide risk assessment tools have been found. On one hand, questionnaires aim at predicting suicidal behaviours (or their recurrence) using a risk score. They are interesting in research but of limited value in clinical practice because of their low specificity and individual predictive power. On the other hand, semi-directive interviews unable clinicians to explore the three dimensions of suicidality (levels of risk, urgency and danger), thus knowing to what extent the patient is suicidal and to adopt the appropriate preventive care strategy. Their use in clinical routine is highly recommended. The Grille d'estimation de la dangerosité d'un passage à l'acte suicidaire is the only interview to have been validated in primary care so far. It could be a pertinent tool in general practice. Preventing suicide in primary care requires the assessment of suicide risk using a semi-directive interview. We suggest a qualitative study to be carried out in general practice on the Grille d'estimation de la dangerosité d'un passage à l'acte suicidaire.