Dataset Information

If You Listen, I Will Talk: the Experience of Being Asked About Suicidality During Routine Primary Care.

ABSTRACT: BACKGROUND:Routine population-based screening for depression is an essential part of evolving health care models integrating care for mental health in primary care. Depression instruments often include questions about suicidal thoughts, but how patients experience these questions in primary care is not known and may have implications for accurate identification of patients at risk. OBJECTIVES:To explore the patient experience of routine population-based depression screening/assessment followed, for some, by suicide risk assessment and discussions with providers. DESIGN:Qualitative, interview-based study. PARTICIPANTS:Thirty-seven patients from Kaiser Permanente Washington who had recently screened positive for depression on the 2-item Patient Health Questionnaire [PHQ] and completed the full PHQ-9. APPROACH:Criterion sampling identified patients who had recently completed the PHQ-9 ninth question which asks about the frequency of thoughts about self-harm. Patients completed semi-structured interviews by phone, which were recorded and transcribed. Directive and conventional content analyses were used to apply knowledge from prior research and elucidate new information from interviews; thematic analysis was used to organize key content overall and across groups based on endorsement of suicide ideation. KEY RESULTS:Four main organizing themes emerged from analyses: (1) Participants believed being asked about suicidality was contextually appropriate and valuable, (2) some participants described a mismatch between their lived experience and the PHQ-9 ninth question, (3) suicidality disclosures involved weighing hope for help against fears of negative consequences, and (4) provider relationships and acts of listening and caring facilitated discussions about suicidality. CONCLUSIONS:All participants believed being asked questions about suicidal thoughts was appropriate, though some who disclosed suicidal thoughts described experiencing stigma and sometimes distanced themselves from suicidality. Direct communication with trusted providers, who listened and expressed empathy, bolstered comfort with disclosure. Future research should consider strategies for reducing stigma and encouraging fearless disclosure among primary care patients experiencing suicidality.

SUBMITTER: Richards JE

PROVIDER: S-EPMC6816586 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

If You Listen, I Will Talk: the Experience of Being Asked About Suicidality During Routine Primary Care.

Richards Julie E JE Hohl Sarah D SD Whiteside Ursula U Ludman Evette J EJ Grossman David C DC Simon Greg E GE Shortreed Susan M SM Lee Amy K AK Parrish Rebecca R Shea Mary M Caldeiro Ryan M RM Penfold Robert B RB Williams Emily C EC

Journal of general internal medicine 20190725 10

<h4>Background</h4>Routine population-based screening for depression is an essential part of evolving health care models integrating care for mental health in primary care. Depression instruments often include questions about suicidal thoughts, but how patients experience these questions in primary care is not known and may have implications for accurate identification of patients at risk.<h4>Objectives</h4>To explore the patient experience of routine population-based depression screening/assess ...[more]

PMID: 31346911

Similar Datasets

Project description:BACKGROUND:Basic parenting research reveals that child mental health is associated with optimal parenting, which is composed of three key dimensions (structure, affiliation and autonomy support). The present study aims to test the efficacy of the parenting program "How to talk so kids will listen & listen so kids will talk" (French version), thought to address all of these dimensions, in promoting children's mental health. We predict that the How-to Parenting Program will promote child mental health by fostering optimal parenting. METHODS:In this randomized controlled trial (RCT), the seven-week parenting group was offered to parents of 5- to 12-year-old children, in their local grade school. Children's mental health assessments were questionnaire-based (parent, child and teacher reports) and took place at pre- (T1) and post- (T2) intervention as well as at 6-month (T3) and 1-year (T4) follow-ups. We compared children whose parents took part in the program with children whose parents did not take part in it until the completion of the trial (i.e., 1 year wait-list control groups). The primary outcome is children's psychological problems (externalizing and internalizing). Secondary outcomes include parenting, the putative mediator of the expected benefits of the program on child mental health, as well as positive indicators of child mental health (strengths and subjective well-being) and parents' own mental health. DISCUSSION:To our knowledge, this is the first RCT to test the efficacy of the "How to talk so kids will listen & listen so kids will talk" program in promoting child mental health. In addition to the close correspondence between basic parenting research and the selected program, strengths of this study include its feasibility, monitoring of potentially confounding variables, ecological validity and inclusion of positive indicators of mental health. TRIAL REGISTRATION:Current clinical trial number is NCT03030352 . Ongoing study, retrospectively registered on January 2017. No amendment to initial protocol.

Project description:BackgroundFrequent users of healthcare services are often categorised as 'heavy-cost patients'. In the recent years, many jurisdictions have attempted to implement different public policies to optimise the use of health services by frequent users. However, throughout this process, little attention has been paid to their experience as patients.ObjectiveTo thematically synthesise qualitative studies that explore the experience of frequent users of primary care and emergency department services.DesignQualitative systematic review and thematic synthesis.SettingPrimary care and emergency department.ParticipantsFrequent users of primary care and emergency department services.MethodsA qualitative systematic review was conducted using three online databases (MEDLINE with full text, CINAHL with full text and PsycINFO). This search was combined to an extensive manual search of reference lists and related citations. A thematic synthesis was performed to develop descriptive themes and analytical constructs.Study selectionTwelve studies were included. All included studies met the following inclusion criteria: qualitative design; published in English; discussed frequent users' experiences from their own perspectives and users' experiences occurred in primary care and/or emergency departments.ResultsThe predominant aspects of frequent users' experiences were: (1) the experience of being ill and (2) the healthcare experience. The experience of being ill encompassed four central themes: physical limitations, mental suffering, impact on relationships and the role of self-management. The healthcare experience embraced the experience of accessing healthcare and the global experience of receiving care.ConclusionThis synthesis sheds light on potential changes to healthcare delivery in order to improve frequent users' experiences: individualised care plans or case management interventions to support self-management of symptoms and reduce psychological distress; and giving greater importance on the patient-providers relationship as a central facet of healthcare delivery. This synthesis also highlights future research directions that would benefit frequent users.

Project description:ObjectiveTo understand disparities in primary care patient experience.DesignA serial cross-sectional study was conducted to understand disparities in patient experience at 2 time points (2014 and 2016). Disparities related to age, gender, neighbourhood income, and self-rated health were explored using 3 analytic approaches: stratification, logistic regression, and relative comparison across multiple demographic variables.SettingA multisite family health team in Toronto, Ont.ParticipantsPatients in the family medicine practice who completed e-mail surveys in 2014 (n = 1171, 19% response rate) and 2016 (n = 1823, 15% response rate).Main outcome measuresPatient-reported access (timely access when sick, access after hours) and patient-centredness (opportunity to ask questions, involvement in care decisions, enough time with provider).ResultsPerformance for all measures improved between 2014 and 2016, with the greatest absolute improvement seen in access after hours (61% in 2014; 75% in 2016). Patients residing in low-income neighbourhoods reported worse patient experiences than those in high-income neighbourhoods did, as did patients with poor versus excellent self-rated health, even after adjustment for other variables. For example, in 2016, 60% of patients residing in low-income neighbourhoods reported timely access when sick versus 70% in high-income neighbourhoods (adjusted odds ratio of 0.67, 95% CI 0.47 to 0.95); 60% of patients with poor or fair self-rated health reported timely access when sick versus 72% with excellent self-rated health (adjusted odds ratio of 0.54, 95% CI 0.35 to 0.84). Comparing across demographic groups, patients with excellent self-rated health and poor or fair self-rated health reported the best and worst experiences, respectively, for all measures. In 2016, the average disparity between subgroups was largest for access after hours.ConclusionIn this setting, patient experience was worse for patients in lower-income neighbourhoods and those with poor or fair self-rated health. Access after hours demonstrated the greatest overall absolute improvement but also the greatest widening of disparities.

Project description:BackgroundPhysician burnout is associated with deleterious effects for physicians and their patients and might be exacerbated by practice transformation.ObjectiveAssess the effect of the Comprehensive Primary Care (CPC) initiative on primary care physician experience.DesignProspective cohort study conducted with about 500 CPC and 900 matched comparison practices. Mail surveys of primary care physicians, selected using cross-sectional stratified random selection 11 months into CPC, and a longitudinal design with sample replacement 44 months into CPC.ParticipantsPrimary care physicians in study practices.InterventionA multipayer primary care transformation initiative (October 2012-December 2016) that required care delivery changes and provided enhanced payment, data feedback, and learning support.Main measuresBurnout, control over work, job satisfaction, likelihood of leaving current practice within 2 years.Key resultsMore than 1000 physicians responded (over 630 of these in CPC practices) in each round (response rates 70-81%, depending on round and research group). Physician experience outcomes were similar for physicians in CPC and comparison practices. About one third of physician respondents in CPC and comparison practices reported high levels of burnout in each round (32 and 29% in 2013 [P = 0.59], and 34 and 36% in 2016 [P = 0.63]). Physicians in CPC and comparison practices reported some to moderate control over work, with an average score from 0.50 to 0.55 out of 1 in 2013 and 2016 (CPC-comparison differences of - 0.04 in 2013 [95% CI - 0.08-0.00, P = 0.07], and - 0.03 in 2016 [95% CI - 0.03-0.02, P = 0.19]). In 2016, roughly three quarters of CPC and comparison physicians were satisfied with their current job (77 and 74%, P = 0.77) and about 15% planned to leave their practice within 2 years (14 and 15%, P = 0.17).ConclusionsDespite requiring substantial practice transformation, CPC did not affect physician experience. Research should track effects of other transformation initiatives on physicians and test new ways to address burnout.Trial registrationClinicalTrials.gov number, NCT02320591.

Dataset Information

If You Listen, I Will Talk: the Experience of Being Asked About Suicidality During Routine Primary Care.

Publications

If You Listen, I Will Talk: the Experience of Being Asked About Suicidality During Routine Primary Care.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets