“Suicide’s very abstract”: A qualitative analysis of risk assessment training recommendations from family physicians

Submitted: 17 May 2024
Accepted: 9 December 2024
Published: 22 January 2025
Abstract Views: 135
PDF: 72
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Suicide risk has consistently increased over the past 2.5 decades, despite growing awareness and tailored programs aimed at combating this epidemic. Suicide prevention initiatives include ensuring 24/7 access to crisis hotlines, encouraging individuals to seek mental health care, and reducing access to lethal means among high-risk populations. A recent area of focus is the physician’s office, as research shows that nearly half of those who die by suicide had seen a primary care physician within one month of their death. However, primary care physicians do not consistently inquire about suicide risk among their patients. This study presents findings from 15 interviews with family medicine residents at a U.S. military hospital. Participants identified gaps in three key areas of training: i) foundational knowledge (e.g., risk assessment flow, available tools and resources, and therapeutic skills), ii) training program structure (e.g., timing, exposure, and effectiveness), and iii) training culture (e.g., fostering courage and support). Residents recognized their central role in suicide prevention and were eager to address perceived gaps in their knowledge. They also shared their ideal training environment, which would support learning and skill development. This paper offers clear and actionable recommendations for family medicine residency programs to advance the suicide prevention agenda.

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Adom, D., Yeboah, A., & Ankrah, A. K. (2016). Constructivism philosophical paradigm: Implication for research, teaching and learning. Global Journal of Arts Humanities and Social Sciences, 4(10), 1-9.
Ahmedani, B. K., Simon, G. E., Stewart, C., Beck, A., Waitzfelder, B. E., Rossom, R., Lynch, F., Owen-Smith, A., Hunkeler, E. M., Whiteside, U., Operskalski, B. H., Coffey, M. J., & Solberg, L. I. (2014). Health care contacts in the year before suicide death. Journal of General Internal Medicine, 29(6), 870–877. DOI: https://doi.org/10.1007/s11606-014-2767-3
American Foundation for Suicide Prevention. (2024). National fact sheet: Suicide statistics and prevention efforts. Available from: https://www.datocms-assets.com/12810/1716221299-afsp_2024_national_fact_sheet_update.pdf
Bachmann, S. (2018). Epidemiology of suicide and the psychiatric perspective. International Journal of Environmental Research and Public Health, 15(7), 1425. DOI: https://doi.org/10.3390/ijerph15071425
Bajaj, P., Borreani, E., Ghosh, P., Methuen, C., Patel, M., & Joseph, M. (2008). Screening for suicidal thoughts in primary care: The views of patients and general practitioners. Mental Health in Family Medicine, 5(4), 229–235.
Bennett, S., Robb, K. A., Zortea, T. C., Dickson, A., Richardson, C., & O'Connor, R. C. (2023). Male suicide risk and recovery factors: A systematic review and qualitative metasynthesis of two decades of research. Psychological Bulletin, 149(7-8), 371–417. DOI: https://doi.org/10.1037/bul0000397
Blandford, A. E. (2013). Semi-structured qualitative studies. In: Soegaard, M. & Dam, R. (eds.), The Encyclopedia of Human-Computer Interaction (pp. 1-53). Interaction Design Foundation.
Bono, V. & Amendola, C. L. (2015). Primary care assessment of patients at risk for suicide. Journal of the American Academy of Physician Assistants, 28(12), 35-39. DOI: https://doi.org/10.1097/01.JAA.0000473360.07845.66
De Leo, D. (2022). Late-life suicide in an aging world. Nature Aging, 2(1), 7-12. DOI: https://doi.org/10.1038/s43587-021-00160-1
Deci, E. L., & Ryan, R. M. (2008a). Self-Determination Theory: A macrotheory of human motivation, development, and health. Canadian Psychology, 49(3), 182-185. DOI: https://doi.org/10.1037/a0012801
Deci, E. L., & Ryan, R. M. (2008b). Facilitating optimal motivation and psychological well-being across life's domains. Canadian Psychology, 49(1), 14-23. DOI: https://doi.org/10.1037/0708-5591.49.1.14
Diamond, G. S., O’Malley, A., Wintersteen, M. B., Peters, S., Yunghans, S., Biddle, V., ... & Schrand, S. (2012). Attitudes, practices, and barriers to adolescent suicide and mental health screening: a survey of Pennsylvania primary care providers. Journal of primary care & community health, 3(1), 29-35. DOI: https://doi.org/10.1177/2150131911417878
Dixon, M. A., Hyer, S. M., & Snowden, D. L. (2021). Suicide in primary care: How to screen and intervene. International Journal of Psychiatry in Medicine, 56(5), 344–353. DOI: https://doi.org/10.1177/00912174211042435
Dueweke, A. R., & Bridges, A. J. (2018). Suicide interventions in primary care: A selective review of the evidence. Families, Systems, & Health, 36(3), 289-302. DOI: https://doi.org/10.1037/fsh0000349
Feldman, M. D., Franks, P., Duberstein, P. R., Vannoy, S., Epstein, R., & Kravitz, R. L. (2007). Let’s not talk about it: Suicide inquiry in primary care. The Annals of Family Medicine, 5(5), 412-418. DOI: https://doi.org/10.1370/afm.719
Graham, R. D., Rudd, M. D., & Bryan, C. J. (2011). Primary care providers’ views regarding assessing and treating suicidal patients. Suicide and Life‐Threatening Behavior, 41(6), 614-623. DOI: https://doi.org/10.1111/j.1943-278X.2011.00058.x
Haas, A. P., Rodgers, P. L., & Herman, J. L. (2014). Suicide attempts among transgender and gender non-conforming adults: Findings of the national transgender discrimination survey. Available from: https://williamsinstitute-law-ucla-edu.libproxy2.usc.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf
Hedegaard, H., Curtin, S. C., & Warner, M. (2018). Suicide rates in the United States continue to increase: Data Brief 309. National Center for Health Statistics. Available from: https://www.cdc.gov/nchs/data/databriefs/db309.pdf
Hoerster, K. D., Lehavot, K., Simpson, T., McFall, M., Reiber, G., & Nelson, K. M. (2012). Health and health behavior differences: U.S. military, veteran, and civilian men. American Journal of Preventive Medicine, 43(5), 483–489. DOI: https://doi.org/10.1016/j.amepre.2012.07.029
Holoshitz, Y., Brodsky, B., Zisook, S., Bernanke, J., & Stanley, B. (2019). Application of the Zero Suicide model in residency training. Academic Psychiatry, 43, 332-336. DOI: https://doi.org/10.1007/s40596-019-01022-0
Hottes, T. S., Bogaert, L., Rhodes, A. E., Brennan, D. J., & Gesink, D. (2016). Lifetime prevalence of suicide attempts among sexual minority adults by study sampling strategies: A systematic review and meta-analysis. American Journal of Public Health, 106(5), E1–E12. DOI: https://doi.org/10.2105/AJPH.2016.303088
Hyer, S. M., & Dixon, M. A. (2022). Motivational Interviewing and Self-Determination Theory in suicide assessment: A practical application to aid residents’ management of suicide. The International Journal of Psychiatry in Medicine, 57(5), 413-422. DOI: https://doi.org/10.1177/00912174221116732
Leavey, G., Mallon, S., Rondon-Sulbaran, J., Galway, K., Rosato, M., & Hughes, L. (2017). The failure of suicide prevention in primary care: Family and GP perspectives–a qualitative study. BMC Psychiatry, 17, 1-10. DOI: https://doi.org/10.1186/s12888-017-1508-7
Martinez-Ales, G., Jiang, T., Keyes, K. M., & Gradus, J. L. (2022). The recent rise in suicide mortality in the United States. Annual Review of Public Health, 43, 99-116. DOI: https://doi.org/10.1146/annurev-publhealth-051920-123206
McDowell, A. K., Lineberry, T. W., & Bostwick, J. M. (2011). Practical suicide-risk management for the busy primary care physician. Mayo Clinic Proceedings, 86(8), 792-800. DOI: https://doi.org/10.4065/mcp.2011.0076
McNamara, K. A., Dixon, M. A., & Moss, D. A. (2024). The Emotional Impact of Suicide Assessment: A Qualitative Study of Military Family Medicine Residents. Family Medicine, 56(8), 509–511. DOI: https://doi.org/10.22454/FamMed.2024.215649
Michail, M., & Tait, L. (2016). Exploring general practitioners’ views and experiences on suicide risk assessment and management of young people in primary care: A qualitative study in the UK. BMJ Open, 6(1), e009654-e009661. DOI: https://doi.org/10.1136/bmjopen-2015-009654
Mwita, K. (2022). Factors influencing data saturation in qualitative studies. International Journal of Research in Business and Social Science (2147-4478), 11(4), 414-420. DOI: https://doi.org/10.20525/ijrbs.v11i4.1776
National Institute of Mental Health. (n.d.). Statistics: Suicide. Available from: https://www.nimh.nih.gov/health/statistics/suicide
Norris, D. R., & Clark, M. S. (2021). The Suicidal Patient: Evaluation and Management. American Family Physician, 103(7), 417–421.
NVivo. (n.d.) [Computer Software]. Version 12.1.1, QSR International; 2018
Olfson, M., Weissman, M. M., Leon, A. C., Sheehan, D. V., & Farber, L. (1996). Suicidal ideation in primary care. Journal of General Internal Medicine, 11, 447-453. DOI: https://doi.org/10.1007/BF02599038
Osborne, De Boer, K., Meyer, D., & Nedeljkovic, M. (2023). Raising suicide in medical appointments—barriers and facilitators experienced by young adults and GPs: A mixed-methods systematic review. International Journal of Environmental Research and Public Health, 20(1), 822-837. DOI: https://doi.org/10.3390/ijerph20010822
Padgett D. K. (2012). Telling the story: Writing up the qualitative study. In Qualitative and Mixed Methods in Public Health.(pp. 221-240). SAGE Publications, Inc. DOI: https://doi.org/10.4135/9781483384511.n10
Paulson, D., & Hidaka, B. (2022). Improving Family Medicine Residents’ Confidence to Assess and Manage Psychiatric Crises in an Outpatient Clinic. Journal of Primary Care & Community Health, 13, 1-8. DOI: https://doi.org/10.1177/21501319221119943
Reimann, C. A., & Mazuchowski, E. L. (2018). Suicide rates among active duty service members compared with civilian counterparts, 2005–2014. Military Medicine, 183(suppl_1), 396-402. DOI: https://doi.org/10.1093/milmed/usx209
Rendle, K. A., Abramson, C. M., Garrett, S. B., Halley, M. C., & Dohan, D. (2019). Beyond exploratory: a tailored framework for designing and assessing qualitative health research. BMJ open, 9(8), e030123. DOI: https://doi.org/10.1136/bmjopen-2019-030123
Rocky Mountain MIRECC for Veteran Suicide Prevention. (n.d.). Therapeutic Risk Management (TRM) with patient at risk for suicide. Available from: https://www.mirecc.va.gov/visn19/trm/
Ryan, E. P., & Oquendo, M. A. (2020). Suicide risk assessment and prevention: Challenges and opportunities. Focus, 18(2), 88-99. DOI: https://doi.org/10.1176/appi.focus.20200011
Ryan, R. M., & Deci, E. L. (2022). Self-determination theory. In Encyclopedia of quality of life and well-being research (pp. 1-7). Cham: Springer International Publishing. DOI: https://doi.org/10.1007/978-3-319-69909-7_2630-2
Ryan, R. M., & Deci, E. L. (2024). Self-Determination Theory. In Encyclopedia of Quality of Life and Well-Being Research (pp. 6229-6235). Cham: Springer International Publishing. DOI: https://doi.org/10.1007/978-3-031-17299-1_2630
Saini, P., Hunt, A., Blaney, P., & Murray, A. (2024). Recognising and responding to suicide-risk factors in primary care: A scoping review. Journal of Prevention (2022: Print), 45(5), 727–750. DOI: https://doi.org/10.1007/s10935-024-00783-1
Schafer, K. M., Duffy, M., Kennedy, G., Stentz, L., Leon, J., Herrerias, G., Fulcher, S., & Joiner, T. E. (2021). Suicidal ideation, suicide attempts, and suicide death among veterans and service members: A comprehensive meta-analysis of risk factors. Military Psychology, 34(2), 129–146. DOI: https://doi.org/10.1080/08995605.2021.1976544
Shea, S. C. (2009, December 21). Suicide Assessment Part 2: Uncovering Suicidal Intent Using the CASE Approach. Psychiatric Times. Available from: https://www.psychiatrictimes.com/view/suicide-assessment-part-2-uncovering-suicidal-intent-using-case-approach
Sherman, M., Justesen, K., & Okocha, E. (2018). Promoting documentation of suicidality in a family medicine residency clinic. Family medicine, 50(2), 138-141. DOI: https://doi.org/10.22454/FamMed.2018.158642
Stickley, A., Koyanagi, A., Ueda, M., Inoue, Y., Waldman, K., & Oh, H. (2020). Physical multimorbidity and suicidal behavior in the general population in the United States. Journal of Affective Disorders, 260, 604-609. DOI: https://doi.org/10.1016/j.jad.2019.09.042
Stovall, J., & Domino, F. J. (2003). Approaching the suicidal patient. American Family Physician, 68(9), 1814-1819.
Tanriover, O., Peker, S., Hidiroglu, S., Kitapcioglu, D., Inanici, S. Y., Karamustafalioglu, N., & Gulpinar, M. A. (2023). The emotions experienced by family medicine residents and interns during their clinical trainings: A qualitative study. Primary Health Care Research & Development, 24(e25), 1-8. DOI: https://doi.org/10.1017/S1463423623000051
U.S. Department of Veterans Affairs. (2023). 2023 National Veteran Suicide Prevention Annual Report. Available from: https://www.mentalhealth.va.gov/suicide_prevention/data.asp
Vos, T., Lim, S. S., Abbafati, C., Abbas, K. M., Abbasi, M., Abbasifard, M., ... & Bhutta, Z. A. (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10258), 1204-1222. DOI: https://doi.org/10.1016/S0140-6736(20)30925-9

How to Cite

Dixon, Mark A., Kathleen A. McNamara, and David A. Moss. 2025. “‘Suicide’s Very abstract’: A Qualitative Analysis of Risk Assessment Training Recommendations from Family Physicians”. Qualitative Research in Medicine and Healthcare 8 (3). https://doi.org/10.4081/qrmh.2024.12676.