Primary care exploration of suicidal ideation by general practitioners before suicidal acts: a national observational study of the French Sentinelles Network

The exploration of suicidal ideation (SI) during primary care consultations with general practitioners (GPs) is crucial for suicide prevention. We performed a retrospective assessment of the prevalence of SI exploration by GPs during the six months preceding suicidal acts with the aim of identifying associated factors, such as the impact of the COVID-19 pandemic. We performed bivariate and multivariate logistic regression analyses on data from weekly questionnaires completed by 459 GPs from the French Sentinelles Network (2013–2023) regarding 1,156 suicidal acts: 928 suicide attempts (SA) and 205 suicides (S). GPs had explored SI during the six months before a suicidal act for 54.9% (95%CI 52.0–57.8) of patients. The prevalence of SI exploration was higher after 2020 (post-COVID period) than before 2020 (61.8% [95%CI: 57.6; 65.8] versus 48.2% [95%CI: 44.0; 52.3], p < 0.001). Factors positively associated with SI exploration were: post-COVID period (OR = 2.25, 95%CI [1.5–3.4], p < 0.001), spontaneous expression of SI (OR = 20.52, 95%CI [9.1–55.7], p < 0.001), consultation for psychological reasons (OR = 3.37, 95%CI [1.9–6.0], p < 0.001), history of SA (OR = 2.10, 95%CI [1.4–3.2], p < 0.001), depression (OR = 1.92, 95%CI [1.3–2.9], p = 0.001), SD versus SA (OR = 1.86, 95%CI [1.1–3.3], p = 0.024), substance misuse (OR = 1.82, 95%CI [1.1–3.0], p = 0.020), consultation within the last month (OR = 1.63, 95%CI [1.1–2.4], p = 0.010). The findings may be subject to a social desirability bias. The exploration of SI needs to be improved, particularly for patients consulting for somatic conditions. GPs may have become more aware of SI since the COVID-19 pandemic. • The COVID pandemic may have increased GPs’ awareness of suicidal ideation • Suicidal ideation is insufficiently explored by GPs when patients have somatic comorbid conditions • Most suicide risk factors influence the exploration of suicidal ideation by GPs