Suicide prevention and first aid


A resource for GPs

Beginning a conversation about suicide

☰ Table of contents


Did you know …


Research shows that the relationship between the GP and the patient can often be one of the most important factors in reducing self-harm ideation – for example, the GP demonstrating empathy and a willingness to discuss emotional concerns.18

Make reassuring statements like:

‘It’s my job to make sure you’re doing OK. I have some concerns that things might not be going so well for you at the moment. Is it OK if we have a bit of a chat about how you are?’

Sometimes it can be daunting asking difficult questions about suicide and mental illness for fear of prying, upsetting the person, stigmatising your patients9 or putting ideas in their head. However, the first step to supporting people considering suicide is to begin a conversation about it. By being calm, non-judgemental and empathetic, a GP provides an opportunity for a client to discuss their suicidal thoughts. They can be encouraged to tell their story, outline their stresses, provide information about their history, and describe their current suicidal thoughts.

While everyone has their own personal communication style, being direct when asking about suicide is imperative. Information about the frequency and intensity of the suicidal thinking, history of suicidal behaviour, current plans, overall mental state, and level of support will inform the overall level of risk and the subsequent management plan required.

Some example questions are highlighted below.


What to ask

  • Do you ever feel like giving up?
  • How does your future seem to you?
  • Does your life ever seem so bad that you wish to die?
  • How often do you have these thoughts? How intense are they?
  • Have you made any plans? If so, what have you been thinking about?
  • How close have you come to doing something?
  • What stops you from doing something?
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  2. Ferrari AJ, Norman RE, Freedman G, et al. The burden attributable to mental and substance use disorders as risk factors for suicide: Findings from the global burden of disease study 2010. PLoS One 2014;9(4):e91936.
  3. Hawton K, van Heeringen K. Suicide. Lancet 2009;373(9672):1372–81.
  4. Australian Bureau of Statistics. Causes of death, Australia, 2014. Cat. no. 3303.0. Canberra: ABS, 2016.  [Accessed 1 February 2016].
  5. Australian Bureau of Statistics. Australian social trends, March, 2011. Cat. no. 4102.0. Canberra: ABS, 2011.  [Accessed 13 January 2016].
  6. Carey M, Jones K, Meadows G, et al. Accuracy of general practitioner unassisted detection of depression. Aust N Z J Psychiatry 2014;48(6):571–78.
  7. beyondblue. Common warning signs. Hawthorn West, Vic: beyondblue, 2016.  [Accessed 14 December 2015].
  8. Mitchell AJ, Rao S, Vaze A. International comparison of clinicians’ ability to identify depression in primary care: Meta-analysis and meta-regression of predictors. Br J Gen Pract 2011;61(583):e72–80. doi:10.3399/bjgp11X556227.
  9. Lampe L, Fritz K, Boyce P, et al. Psychiatrists and GPs: Diagnostic decision making, personality profiles and attitudes toward depression and anxiety. Australas Psychiatry 2013;21(3):231–37.
  10. Wilhelm KA, Finch AW, Davenport TA, Hickie IB. What can alert the general practitioner to people whose common mental health problems are unrecognised? Med J Aust 2008;188(12 Suppl):S114–18.
  11. Kyrios M, Mouding R, Nedeljkovic M. Anxiety disorders – Assessment and management in general practice. Aust Fam Physician 2011;40(6):370–74.
  12. Nepon J, Belik SL, Bolton J, Sareen J. The relationship between anxiety disorders and suicide attempts: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Depress Anxiety 2010;27(9):791–98.
  13. beyondblue. What causes anxiety? Hawthorn West, Vic: beyondblue, 2016.  [Accessed 16 February 2016].
  14. Stensland MD, Zhu B, Ascher-Svanum H, Ball DE. Costs associated with attempted suicide among individuals with bipolar disorder. J Ment Health Policy Econ 2010;13(2):87–92.
  15. Cerimele JM, Chwastiak LA, Chan YF, Harrison DA, Unutzer J. The presentation, recognition and management of bipolar depression in primary care. J Gen Intern Med 2013;28(12):1648–56.
  16. Black Dog Institute. Bipolar disorder: Symptoms. Randwick, NSW: Black Dog Institute, 2012. [Accessed 4 February 2016].
  17. Benazzi F. Bipolar disorder – Focus on bipolar II disorder and mixed depression. Lancet 2007;369(9565):935–45.
  18. Almeida OP, Pirkis J, Kerse N, et al. A randomized trial to reduce the prevalence of depression and self-harm behavior in older primary care patients. Ann Fam Med 2012;10(4):347–56.
  19. Women’s Web. Analogies to help one understand depression and other mental health conditions. Women’s Web, 2014.  [Accessed 3 March 2016].
  20. Parker J. Recovery in mental health. S Afr Med J 2014;104(1):77.
  21. Lloyd C, Waghorn G, Williams PL. Conceptualising recovery in mental health rehabilitation. Br J Occup Ther 2008;71(8):321–28.
  22. Department of Health. Principles of recovery oriented mental health practice. Canberra: DoH, 2010. [Accessed 3 March 2016].
  23. Sivasankaran B. Mental health risk assessment: A guide for GPs. Aust Fam Physician 2011;40(6):366–69.  [Accessed 30 May 2016].
  24. Hawgood J, De Leo D. Screening tool for assessing risk of suicide (STARS). Nathan, Qld: Australian Institute for Suicide Research and Prevention, Griffith University, 2015. [Accessed 3 March 2016].
  25. Melvin GA, Gresham D, Beaton S. Safety first – not last! Suicide Safety Planning Intervention (SPI). InPsych 2016; 38(1):14–15. 
    [Accessed 30 May 16].
  26. Zantinge EM, Verhaak PF, de Bakker DH, van der Meer K, Bensing JM. Does burnout among doctors affect their involvement in patients’ mental health problems? A study of videotaped consultations. BMC Fam Pract 2009;10:60.
  27. Wade D, Howard A, Fletcher S, Cooper J, Forbes D. Early response to psychological trauma – What GPs can do. Aust Fam Physician 2013;42(9):610–14.
  28. Brondt A, Sokolowski I, Olesen F, Vedsted P. Continuing medical education and burnout among Danish GPs. Br J Gen Pract 2008;58(546):15–19.

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