Teaching medical professionals about suicide prevention: what's missing?

Worldwide, every year, about a million lives are lost through suicide, representing 1.5% of the global burden of disease and accounting for more than 20 million Disability-Adjusted Life Years (years of healthy life lost through premature death or disability).1 Currently, in the USA, suicide is the 11th leading cause of death, and accounts for more than 30 000 deaths every year, a rate of about 11/100 000.2,3 According to the UK Office for National Statistics, there were 5 675 suicides in the UK in 2009.4 Suicides may be underreported or underestimated because of medical examiner or coroner experience, social and other factors such as stigma. Opinions differ regarding the magnitude of the underestimation, ranging from 10% to 50%.3 Despite increased awareness of suicide as a major social and medical problem, many health care professionals who have frequent contact with high-risk patients do not have adequate training in suicide assessment techniques and treatment approaches to suicidal patients.5,6 Studies in the USA and the UK have found that residency trainees, junior physicians and clinical psychology trainees report receiving little training or reading assignments on the assessment and management of suicidal behavior.7–11 Some physicians do not understand the clinical rationale for suicide risk assessment and the role they play in preventing suicidal behavior.12 The US Preventive Services Task Force found that primary care providers need to improve their skills to manage and assess suicide risk.13 Studies in Sweden, Hungary and Germany conducted over the past 30 years have shown that current methods of training general practitioners in the recognition and management of suicidality are effective but not very effective.14–17 Medical students receive little training regarding suicide prevention and continuing education offerings for practicing physicians are few.12,18–21 …