A recently published systematic review by Australian researchers from Swinburne University has examined the barriers and facilitators experienced by young adults and general practitioners (GPs) in raising the discussion of suicide during medical appointments. They found that young adults want GPs to initiate the conversation, however many GPs lack confidence and skills to assess suicide risk in young adults.
With high rates of suicidal thoughts and behaviours among adolescents and young adults, it is important that helpful support and treatment is available. Most young adults will see a GP on a regular basis, which presents an opportunity to identify those experiencing suicidal thoughts or behaviours and intervene.
Comprehensive training for GPs and introducing suicide risk screening in primary care for young adults should be a priority intervention for GPs to implement. Young adults reported that they ‘did not mind being asked about self-harm as long as it was in an empathetic way’.
The study identified that the barriers to young adults disclosing suicidal thoughts and behaviours to a GP included concerns about consequences and negative judgement. Of concern, some GPs expressed negative attitudes towards discussing suicide with young adults, for example not wanting to ‘open a can of worms’, or that young adults expressing thoughts of suicide are ‘attention seeking’.
GPs and young adults alike noted the lack of time in regular GP consultations as a barrier to discussions about suicide. Young adults could tell GPs felt rushed, which ‘impacted the GPs ability to identify problems, see the whole picture, and hindered the development of a genuine connection with the young person’.
The review found that therapeutic skills training enhanced the ability of GPs to raise suicide during medical appointments as well as aided disclosure by young adults. Better systems and tools to support GPs to manage suicidal young adults in primary care were also seen as beneficial, for example in-house multidisciplinary care teams or guides and flowcharts with referral pathways.
“While these resources may not directly facilitate young adults to disclose suicidal thoughts and behaviours in a medical appointment, it may be that, for GPs, knowing that they have the resources and support to manage young adults who are suicidal in primary care will, in turn, encourage or support them to proactively increase their enquiry of suicidal thoughts and behaviours with young adults,” said the researchers.