Red Book



There is a lack of evidence for the routine screening of patients using a screening instrument (C). GPs should be alert for higher-risk individuals and the possibility of suicide in these patients. There is evidence that detecting and treating depression has a role in suicide prevention.44,45 For example, the incidence of suicide has decreased in older men and women in association with exposure to antidepressants.31,46

 Suicide: Identifying risk

Table 10.2.1

Suicide: Identifying risk

Tests to detect suicide risk

Table 10.2.2

Tests to detect suicide risk

  1. The Royal Australian College of General Practitioners. Abuse and violence: Working with our patients in general practice. East Melbourne, Vic: RACGP, 2014.
  2. Rees S, Silove D, Chey T, et al. Lifetime prevalence of gender-based violence in women and the relationship with mental disorders and psychosocial function. JAMA 2011;306(5):513–21.
  3. Slade T, Johnston A, Oakley Browne MA, Andrews G, Whiteford H. 2007 National Survey of Mental Health and Wellbeing: Methods and key findings. Aust N Z J Psychiatry 2009;43(7):594–605.
  4. Campbell J, Laughon K, Woods A. Impact of intimate partner abuse on physical and mental health: How does it present in clinical practice? In: Roberts G, Hegarty K, Feder G, editors. Intimate partner abuse and health professionals: New approaches to domestic violence. Edinburgh: Churchill Livingstone, 2006; p. 43–60.
  5. Cameron IM, Lawton K, Reid IC. Recognition and subsequent treatment of patients with sub-threshold symptoms of depression in primary care. J Affect Disord 2011;130(1–2):99–105.
  6. Wee LE, Yong YZ, Chng MWX, et al. Individual and area-level socioeconomic status and their association with depression amongst community-dwelling elderly in Singapore. Aging Ment Health 2014;18(5):628–41.
  7. Zaninotto L, Souery D, Calati R, et al. Mixed, melancholic, and anxious features in depression: A cross-sectional study of sociodemographic and clinical correlates. Ann Clin Psychiatry 2014;26(4):243–53.
  8. Harris MF, Harris E, Shortus TD. How do we manage patients who become unemployed? Med J Aust 2010;192(2):98–101.
  9. Rizvi SJ, Cyriac A, Grima E, et al. Depression and employment status in primary and tertiary care settings. Can J Psychiatry 2015;60(1):14–22.
  10. Milner A, Krnjacki L, Butterworth P, Kavanagh A, LaMontagne AD. Does disability status modify the association between psychosocial job quality and mental health? A longitudinal fixed-effects analysis. Soc Sci Med 2015;144:104–11.
  11. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health: Results from the World Health Surveys. Lancet 2007;370(9590):851–58.
  12. O’Toole TP, Johnson EE, Redihan S, Borgia M, Rose J. Needing primary care but not getting it: The role of trust, stigma and organizational obstacles reported by homeless veterans. J Health Care Poor Underserved 2015;26(3):1019–31.
  13. Patel V, Lund C, Hatherill S, et al. Mental disorders: Equity and social determinants. In: Blas E, Kurup AS, editors. Equity, social determinants and public health programmes. Geneva: WHO, 2010.
  14. Richardson R, Westley T, Gariepy G, Austin N, Nandi A. Neighborhood socioeconomic conditions and depression: A systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2015;50(11):1641–56.
  15. Denney JT, Wadsworth T, Rogers RG, Pampel FC. Suicide in the city: Do characteristics of place really influence risk? Soc Sci Q 2015;96(2):313–29.
  16. Milner AJ, Niven H, LaMontagne AD. Occupational class differences in suicide: Evidence of changes over time and during the global financial crisis in Australia. BMC Psychiatry 2015;15(1):223.
  17. Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander Peoples 2015. Canberra: AIHW, 2015.
  18. Kelaher MA, Ferdinand AS, Paradies Y. Experiencing racism in health care: The mental health impacts for Victorian Aboriginal communities. Med J Aust 2014;201(1):44–47.
  19. Cunningham J, Paradies YC. Socio-demographic factors and psychological distress in Indigenous and nonIndigenous Australian adults aged 18–64 years: Analysis of national survey data. BMC Public Health 2012;12:95.
  20. Furler J, Kokanovic R, Dowrick C, Newton D, Gunn J, May C. Managing depression among ethnic communities: A qualitative study. Ann Fam Med 2010;8(3):231–36.
  21. Lang IA, Llewellyn DJ, Hubbard RE, Langa KM, Melzer D. Income and the midlife peak in common mental disorder prevalence. Psychol Med 2011;41(7):1365–72.
  22. Green MJ, Benzeval M. The development of socioeconomic inequalities in anxiety and depression symptoms over the lifecourse. Soc Psychiatry and Psychiatr Epidemiol 2013;48(12):1951–61.
  23. Collado MAO, Saez M, Favrod J, Hatem M. Antenatal psychosomatic programming to reduce postpartum depression risk and improve childbirth outcomes: A randomized controlled trial in Spain and France. BMC Pregnancy Childbirth 2014 Jan;14:22.
  24. Lansakara N, Brown SJ, Gartland D. Birth outcomes, postpartum health and primary care contacts of immigrant mothers in an Australian nulliparous pregnancy cohort study. Matern Child Health J 2010;14(5):807–16.
  25. O’Mahony JM, Donnelly TT. How does gender influence immigrant and refugee women’s postpartum depression help-seeking experiences? J Psychiatr Ment Health Nurs 2013;20(8):714–25.
  26. O’Mahony JM, Donnelly TT, Bouchal SR, Este D. Cultural background and socioeconomic influence of immigrant and refugee women coping with postpartum depression. J Immigr Minor Health 2013;15(2):300–14.
  27. National Aboriginal Community Controlled Health Organisation and The Royal Australian College of General Practitioners. National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people. 2nd edn. Melbourne: RACGP, 2012.
  28. Fahey JO, Shenassa E. Understanding and meeting the needs of women in the postpartum period: The perinatal maternal health promotion model. J Midwifery Womens Health 2013;58(6):613–21.
  29. Meltzer-Brody S, Stuebe A. The long-term psychiatric and medical prognosis of perinatal mental illness. Best Pract Res Clin Obstet Gynaecol 2014;28(1):49–60.
  30. Fung K, Dennis CL. Postpartum depression among immigrant women. Curr Opin Psychiatry 2010;23(4):342– 48.
  31. Siu AL, US Preventive Services Task Force. Screening for depression in adults, US Preventive Services Task Force recommendation statement. JAMA 2016;315(4):380–87.
  32. Siu AL, US Preventive Services Task Force. Screening for depression in children and adolescents: US Preventive Services Task Force recommendation statement. Ann Int Med 2016;164(5):360–66.
  33. National Collaborating Centre for Mental Health. National Institute for Health and Clinical Excellence: Guidance. Depression: The treatment and management of depression in adults (updated edition). Leicester
  34. (UK): British Psychological Society and Royal College of Psychiatrists, 2010.
  35. Health Quality Ontario. Screening and management of depression for adults with chronic diseases: An evidence-based analysis. Ont Health Technol Assess Ser 2013;13(8):1–45.
  36. King M, Semlyen J, Tai SS, et al. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry 2008;8:70.
  37. Canadian Task Force on Preventive Health Care, Joffres M, Jaramillo A, et al. Recommendations on screening for depression in adults. CMAJ 2013 Jun 11;185(9):775–82.
  38. Lereya ST, Copeland WE, Zammit S, Wolke D. Bully/ victims: A longitudinal, population-based cohort study of their mental health. Eur Child Adolesc Psychiatry 2015;24(12):1461–71.
  39. Sanci L, Lewis D, Patton G. Detecting emotional disorder in young people in primary care. Curr Opin Psychiatry 2010;23(4):318–23.
  40. Thapar A, Collishaw S, Pine DS, Thapar AK. Depression in adolescence. Lancet 2012;379(9820):1056–67.
  41. Chown P, Kang M, Sanci L, Newnham V, Bennett DL. Adolescent health: Enhancing the skills of general practitioners in caring for young people from culturally diverse backgrounds – GP resource kit; 2nd edn. Sydney: NSW Centre for the Advancement of Adolescent Health and Transcultural Mental Health Centre, 2008.
  42. McDermott B, Baigent M, Chanen A, et al. Clinical practice guidelines: Depression in adolescents and young adults. Hawthorn, Vic: beyondblue, 2010.
  43. Arroll B, Goodyear-Smith F, Kerse N, Fishman T. Effect of the addition of a ‘help’ question to two screening questions on specificity for diagnosis of depression in general practice: Diagnostic validity study. BMJ 2005;331(7521):884.
  44. Austin MP, Highet N, the Guidelines Expert Advisory Committee. Clinical practice guidelines for depression and related disorders – anxiety, bipolar disorder and puerperal psychosis – in the perinatal period. A guideline for primary care health professionals. Hawthorn, Vic: beyondblue, 2011.
  45. Gaynes B N, West SL, Ford CA, Frame P, Klein J, Lohr KN. Screening for suicide risk in adults: A summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 2004;140(10):822–35.
  46. Goldney RD. Suicide prevention: A pragmatic review of recent studies. Crisis 2005;26(3):128–40.
  47. Hall W, Mant A, Mitchell PB, Rendle VA, Hickie IB. Association between antidepressant prescribing and suicide in Australia, 1991–2000 trend analysis. BMJ 2003;326(7397):1008–12.
  48. Goldney RD. Suicide prevention. Oxford, UK: Oxford University Press, 2008.
  49. LeFevre ML, US Preventive Services Task Force. Screening for suicide risk in adolescents, adults, and older adults in primary care: US Preventive Services Task Force recommendation statement. Ann Intern Med 2014;160(10):719–26.
  50. US Preventive Services Task Force. The guide to clinical preventive services 2014: Recommendations of the US Preventive Services Task Force. Rockville, MD: US Preventive Task Force. 2014. Available at www. [Accessed 1 November 2015].
  51. Large MM, Nielssen OB. Suicide in Australia: Metaanalysis of rates and methods of suicide between 1988 and 2007. Med J Aust 2010;192(8):432–37.
  52. World Health Organization, Department of Reproductive Health and Research London School of Hygiene and Tropical Medicine, South African Medical Research Council. Global and regional estimates of violence against women. Prevalence and health effects of intimate partner violence and non-partner sexual violence. Geneva: WHO, 2013.
  53. World Health Organization. Responding to intimate partner violence and sexual violence against women. WHO clinical and policy guidelines. Geneva: WHO, 2013.
  54. O’Doherty LJ, Taft A, Hegarty K, Ramsay J, Davidson LL, Feder G. Screening women for intimate partner violence in healthcare settings: Abridged Cochrane systematic review and meta-analysis. BMJ 2014;348:g2913.
  55. Feder G, Davies RA, Baird K, et al. Identification and referral to improve safety (IRIS) of women experiencing domestic violence with primary care training and support programme: A cluster randomised controlled trial. Lancet 2011;378(9805):1788–95.
  56. Hegarty K, O’Doherty L, Taft A, et al. Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): A cluster randomised controlled trial. Lancet 2013;382(9888):249–58.
  57. Bair-Merritt MH, Lewis-O’Connor A, Goel S, et al. Primary care-based interventions for intimate partner violence: A systematic review. Am J Prev Med 2014;46(2):188–94.
  58. Sanci L, Chondros P, Sawyer S, et al. Responding to young people’s health risks in primary care: A cluster randomised trial of training clinicians in screening and motivational interviewing. PLOS ONE 2015;10(9):e0137581.
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