This news story was first published in print and online by The Medical Republic on the 10th February 2016.


Better GP training and resources for could save 160 of the 2500 lives lost to suicide per year in Australia, according to a study in the Australia and New Zealand Journal of Psychiatry.

This was assessed to be one of the most effective of nine different suicide-prevention strategies assessed by researchers at the Black Dog Institute. The study also looked at the applied evidence for psychosocial treatments, reduced access to suicide means and public awareness campaigns in an attempt to inform future policy and funding.

Because over three quarters of Australia people who die by suicide see their doctor within three months of doing so there is great potential to intervene, said the Black Dog Institute’s GP program developer, Dr Vered Gordon.

She said that beyond usual markers of depression there are some particular warning signs to look out for, such as “agitation, volatility in mood, increase in sleep disruption, a sense of hopelessness of feeling trapped.” But patients sometimes present with somatic symptoms of distress like headaches and abdominal distress and may come in asking for painkillers.

“Asking just a couple of questions about whether someone is enjoying things in their normal way can give a quick indications whether one needs to go into a more mental health-based consultation,” said Dr Gordon. She said that that ten-minute GP consultations couldn’t provide a sufficient safety net on their own, but that further resources were needed to train practice nurses and coordinate clinics with community mental health teams and carers that could monitor at-risk patients over a longer term.

The ANZJP study estimated same sort of coordinated care for the 27,112 people treated annually by emergency departments after attempted suicide could bring these numbers down by one-fifth. This is the group at highest risk of another attempt, and represent a ‘low hanging fruit’ for intervention, said Professor John Mendoza, director of ConNetica, a suicide prevention think tank.

But he said that social and personal factors such as loss of employment and abandonment by a partner should also not be overlooked. “In my area on the sunshine coast we had 35 suicides in three months last year. A lot of those were FIFO workers from the mines,” said Professor Mendoza. He said suddenly finding themselves underemployed and financially overcommitted was a huge stressor, on top of the pressured and disrupted lifestyle of the mining industry.

Professor Mendoza said that unreleased estimates of Queensland’s suicides from last year are ‘frightening.’ “I don’t want to be too dramatic, but the numbers we’re aware of indicate that we’re on track for 2015 to be an extraordinarily bad year.” This trend goes against the target championed by the National Mental Health Commission of a 50% reduction in suicide rates within a decade.

The study by the Black Dog Institute was part of a program examining how multiple suicide-prevention strategies might work to complement each other synergistically in a systems approach. For example, a public information campaign on its own might have little effect but if it motivates people to seek help from GPs, who have themselves being given suitable training, then the combined benefits would be more that additive.

However Professor Mendoza said that examining only the studies that fit strict clinical designs ignored many important factors. “The prism with which the authors have chosen the nine-best interventions is entirely a medical construct, not a sociological or cultural one.”

He gave the example of a program to put young indigenous people in remote communities in appropriate housing, education and employment. The incidental decrease or even abolition of suicides in some communities revealed determinants of suicidality that would never be captured by the strict ‘evidence-based’ assessment.

Professor Mendoza said that better collection and reporting of suicide data was needed in Australia before funding and policy could be committed effectively. In many European countries cases of probable suicide are also noted, he said, revealing a very different picture of the problem. “Even traffic accidents fall into that category. Some researchers say that as many as one in ten deaths on the road are suicides.”

Further, people that are hospitalized with traumatic injuries from suicide attempts often give misleading cover stories, said Professor Mendoza, while twice as many never present to hospital at all.

ANZJP. 2016 Feb;50(2):115-8