| Additional Support for Patients with Suicide Risk |
Overall Rank: 4 |
Additional support (e.g., more frequent direct contacts with primary health care staff or telephone contacts) should be considered for patients with depression who are assessed to be at high risk of suicide.
Domain : Patients with Acute Conditions
This special area domain refers to those patients whose conditions require an immediate intervention, such as an emergency room visit.
Additional Domain(s) : Patient-Centeredness, Patients with Mood Disorders
Rationale
There is more evidence for the effectiveness of antidepressant medication in moderate to severe depression than in milder depression. Antidepressants are as effective as psychological interventions, widely available and cost less.
Careful monitoring of symptoms, side effects and suicide risk (particularly in those aged under 30) should be routinely undertaken, especially when initiating antidepressant medication. Patient preference and past experience of treatment, and particular patient characteristics should inform the choice of drug. It is also important to monitor patients for relapse and discontinuation/withdrawal symptoms when reducing or stopping medication. Patients should be warned about the risks of reducing or stopping medication.
Randomised controlled trial (RCT) evidence indicates that for many patients there is little clinically important difference between antidepressants and placebo, and the placebo response is greatest in mild depression.
Primary Reference
The National Institute for Clinical Excellence. (2004). Depression-Management of depression in primary and secondary care: Clinical Guideline. London, United Kingdom. Retrieved on Aug 3, 2006 from: http://www.nice.org.uk/page.aspx? o=cg023niceguideline
Level of Evidence
IV: Evidence based on individual expert opinion.
- Often PHC staff and MH staff assess and manage suicide risk differently - with little communication or understanding between the two groups. I think the bulk of this responsibility should be referred to MH once initial risks noted
- Should add: And/or family/community supports
- Consider individual peer support or group-based peer support (ie 12-step model).
Variation in Results
|
Ratings-based Rank
| Relevance |
2 |
| Actionability |
6 |
| Overall Importance |
10 |
|
|
Stakeholder Rank
| Academics |
6 |
| Clinicians |
13 |
| Consumers |
1 |
| Decision Makers |
7 |
� |
|
Special Group Rank
| First Nations |
11 |
| Rural Areas |
5 |
| Federal Stakeholders |
10 |
|
Regional Rank
| BC |
AB |
SK |
MB |
ON |
QC |
NB |
NS |
PE |
NL |
YT |
NT |
NU |
| 18 |
11 |
18 |
16 |
5 |
15 |
4 |
22 |
12 |
21 |
26 |
20 |
37 |
|
|
Overall Rank
|
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