Guidelines for preventive activities in general practice

Mental health and substance use

Suicide

      1. Suicide

Mental health and substance use | Suicide

There are over 3000 deaths due to suicide in Australia each year,1 and hence this is a key priority for governments and the healthcare system. Given that GPs see almost nine in 10 Australians each year,2 they are viewed as a key part of the solution to detecting people most at risk of suicide and offering them appropriate interventions.3 Contact with primary healthcare services is common in the months or weeks prior to suicide.1,4

The suicide rate is threefold higher for men than women.1 The causes of suicidality are complex and diverse, but there is an association between suicide and psychiatric conditions,5 and there is some evidence that treatment of mental health conditions can reduce risk.7 People affected by complex mental health issues are anywhere from 10- to 45-fold more likely to die by suicide than the general population.8 The risk is highest for those living with borderline personality disorder (BPD), one of the most stigmatised and poorly understood conditions, but it is also high for those living with anorexia nervosa (31-fold higher than in the general population) and schizophrenia (13-fold higher than in the general population).8

Although traumatic experiences can increase the risk of suicide, the effects of trauma can be protracted over a period of time or lifelong. For example, adverse childhood events can be a risk factor for mental ill health. Historical experiences of trauma should not be discounted as a current risk factor for suicidal behaviour and poor mental health.9

Screening

Recommendation Grade How often References
Routine screening for suicide risk is not recommended. Not recommended (Strong) N/A 10

Case finding

Recommendation Grade How often References
Be alert for the risk of attempted suicide in those with:
  • mental illness, especially mood disorders, and alcohol and drug abuse
  • previous suicide attempts or deliberate self-harm
  • recent loss or other adverse event
  • access to harmful means, such as medication or weapons
  • legal or disciplinary problems
  • relationship problems, such as conflict with parents or intimate partner
  • bullying
  • a family history of attempted or completed suicide
  • a recent bereavement
  • chronic and terminal medical illness
as well as those:
  • who are living alone
  • who are/have been in prison
  • who have been discharged from a psychiatric hospital in the previous 12 months
  • are women experiencing intimate partner violence  
Practice point Opportunistically 11,12,13
 

Although there is lack of evidence for routine screening for suicide using a screening instrument, a case finding approach rather than universal screening is recommended given that there are clearly defined patient groups known to be at greater risk. GPs should be alert for patients who are at higher risk of self-harm and suicide. Mental health first aid strategies can be offered in general practice and are recognised as an effective strategy for suicide prevention.3 The system-based strategy that has the greatest estimated reduction in suicide deaths is GP capacity building and support.14

The General Practice Mental Health Standards Collaboration (GPMHSC) provides guidelines written specifically for GPs to assist with suicide prevention and first aid.2 These guidelines provide the types of questions to ask those identified as being at risk and some effective strategies for managing risk. Conceptualising risk according to both static and dynamic factors can also assist the GP in the clinical assessment of a patient regarding level of risk.15

There is a higher incidence of attempted suicide among Aboriginal and Torres Strait Islander peoples.1 For specific recommendations and advice for Aboriginal and Torres Strait Islander people, please refer to the Prevention of suicide section in the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.

There is a higher incidence of attempted suicide in LGBTIQA+ communities.1

  1. Australian Institute of Health and Welfare. Suicide & self-harm monitoring. Australian Government, 2023 [Accessed 5 March 2024].
  2. The Royal Australian College of General Practitioners (RACGP). General practice: Health of the nation 2022. RACGP, 2022 [Accessed 6 March 2024].
  3. General Practice Mental Health Standards Collaboration (GPMHSC). Suicide prevention and first aid: A resource for GPs. GPMHSC, 2016 [Accessed 6 March 2024].
  4. Spottswood M, Lim CT, Davydow D, Huang H. Improving suicide prevention in primary care for differing levels of behavioral health integration: A review. Front Med (Lausanne) 2022;9:892205. doi: 10.3389/fmed.2022.892205.
  5. Hawton K, van Heeringen K. Suicide. Lancet 2009;373(9672):1372–81. doi: 10.1016/S0140-6736(09)60372-X.
  6. 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. beyondblue, 2011.
  7. Gaynes BN, West SL, Ford CA, et al. Screening for suicide risk in adults: A summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2004;140(10):822–35. doi: 10.7326/0003-4819-140-10-200405180-00015.
  8. SANE. Decrease in suicide rates is not a time for celebration. SANE, 2017.Available at [Accessed 5 March 2024].
  9. Australian Institute of Health and Welfare. Stress and trauma. Australian Government, 2024 [Accessed 14 March 2024].
  10. U.S. Preventive Services Task Force (USPSTF). Suicide risk in adolescents, adults and older adults: Screening. USPSTF, 2023 [Accessed 5 March 2024].
  11. BeyondBlue. Suicide. Beyond Blue, n.d [Accessed 5 March 2024].
  12. Powell J, Geddes J, Deeks J, Goldacre M, Hawton K. Suicide in psychiatric hospital in-patients. Risk factors and their predictive power. Br J Psychiatry 2000;176(3):266–72. doi: 10.1192/bjp.176.3.266.
  13. Favril L, Yu R, Uyar A, Sharpe M, Fazel S. Risk factors for suicide in adults: Systematic review and meta-analysis of psychological autopsy studies. Evid Based Ment Health 2022;25(4):148–55. doi: 10.1136/ebmental-2022-300549.
  14. Black Dog Institute. An evidence-based systems approach to suicide prevention: guidance on planning, commissioning and monitoring. Black Dog Institute, 2016 [Accessed 5 March 2024].
  15. Balaratnasingam S. Mental health risk assessment – a guide for GPs. Aust Fam Physician 2011;40(6):366–69.
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