Advertisement

Primary Care Behavioral Health (PCBH) Model and Suicide

  • Alexander D. Smith
  • Meghan D. M. Fondow
  • Elizabeth A. Zeidler Schreiter
Chapter

Abstract

The goal of the following chapter is to serve as a primer on suicidality presenting in primary care and how integrated care can support improvements in practice. The state of current screening and treatment for suicidality within primary care will be reviewed, including current training of primary care providers and needed areas of additional training and support. The ways in which integrated care can be utilized to improve practice in primary care as related to suicidality will be addressed, and a brief overview of the Primary Care Behavioral Health (PCBH) model will be provided. Finally, the specifics of the PCBH program in which the authors practice will be discussed as an example of how care is provided in a Federally Qualified Health Center.

Keywords

Primary Care Behavioral Health Integrated care Behavioral health consultant Primary care Federally Qualified Health Center Behavioral medicine Suicide risk assessment Suicide risk intervention 

References

  1. 1.
    Olfson M, Weissman MM, Leon AC, Sheehan DV, Farber L. Suicidal ideation in primary care. J Gen Intern Med. 1996;11(8):447–53.  https://doi.org/10.1370/afm.719. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Schulberg HC, Bruce ML, Lee PW, Williams JW, Dietrich AJ. Preventing suicide in primary care patients: the primary care physician’s role. Gen Hosp Psychiatry. 2004;26(5):337–45.  https://doi.org/10.1016/j.genhosppsych.2004.06.007.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ahmedani BK, Simon GE, Stewart C, Beck A, Waitzfelder BE, Rossom R, et al. Health care contacts in the year before suicide death. J Gen Intern Med. 2014;29(6):870–7.  https://doi.org/10.1007/s11606-014-2767-3.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Luoma JB, Martin CE, Pearson JL. Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry. 2002;159(6):909–16.  https://doi.org/10.1176/appi.ajp.159.6.909.CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    O’Connor E, Gaynes BN, Burda BU, Soh C, Whitlock EP. Screening for and treatment of suicide risk relevant to primary care: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013;158(10):741–54.  https://doi.org/10.7326/0003-4819-158-10-201305210-00642.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Bauer AM, Chan YF, Huang H, Vannoy S, Unützer J. Characteristics, management, and depression outcomes of primary care patients who endorse thoughts of death or suicide on the PHQ-9. J Gen Intern Med. 2013;28(3):363–9.  https://doi.org/10.1007/s11606-012-2194-2.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kroenke K, Spitzer RL, Williams JB, Löwe B. The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry. 2010;32(4):345–59.  https://doi.org/10.1016/j.genhosppsych.2010.03.006.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Yeung AS, Jing Y, Brenneman SK, Chang TE, Baer L, Hebden T, et al. Clinical Outcomes in Measurement-based Treatment (COMET): a trial of depression monitoring and feedback to primary care physicians. Depress Anxiety. 2012;29(10):865–73.  https://doi.org/10.1002/da.21983.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.  https://doi.org/10.1046/j.1525-1497.2001.016009606. CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Uebelacker LA, German NM, Gaudiano BA, Miller IW. Patient Health Questionnaire depression scale as a suicide screening instrument in depressed primary care patients: a cross-sectional study. Prim Care Companion CNS Disord. 2011;13(1).  https://doi.org/10.4088/PCC.10m01027.
  11. 11.
    Simon GE, Rutter CM, Peterson D, Oliver M, Whiteside U, Operskalski B, et al. Does response on the PHQ-9 Depression Questionnaire predict subsequent suicide attempt or suicide death? Psychiatr Serv. 2013;64(12):1195–202.  https://doi.org/10.1176/appi.ps.201200587.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Nock MK, Hwang I, Sampson NA, Kessler RC. Mental disorders, comorbidity and suicidal behavior: results from the National Comorbidity Survey Replication. Mol Psychiatry. 2010;15(8):868–76.  https://doi.org/10.1038/mp.2009.29.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782–6.  https://doi.org/10.1192/bjp.150.6.782. CrossRefPubMedGoogle Scholar
  14. 14.
    Zhong QY, Gelaye B, Rondon MB, Sánchez SE, Simon GE, Henderson DC, et al. Using the Patient Health Questionnaire (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS) to assess suicidal ideation among pregnant women in Lima, Peru. Arch Womens Ment Health. 2015;18(6):783–92.  https://doi.org/10.1007/s00737-014-0481-0.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kim JJ, La Porte LM, Saleh MP, Allweiss S, Adams MG, Zhou Y, et al. Suicide risk among perinatal women who report thoughts of self-harm on depression screens. Obstet Gynecol. 2015;125(4):885–93.  https://doi.org/10.1097/AOG.0000000000000718.CrossRefPubMedGoogle Scholar
  16. 16.
    Howard LM, Flach C, Mehay A, Sharp D, Tylee A. The prevalence of suicidal ideation identified by the Edinburgh Postnatal Depression Scale in postpartum women in primary care: findings from the RESPOND trial. BMC Pregnancy Childbirth. 2011;11:57.  https://doi.org/10.1186/1471-2393-11-57. CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011;168(12):1266–77.  https://doi.org/10.1176/appi.ajp.2011.10111704.CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Posner K, Subramany R, Amira L, Mann JJ. From uniform definitions to prediction of risk: the Columbia Suicide Severity Rating Scale approach to suicide risk assessment. In: Cannon KE, Hudzik TJ, editors. Suicide: phenomenology and neurobiology. Cham: Springer; 2014. p. 59–84.Google Scholar
  19. 19.
    Viguera AC, Milano N, Laurel R, Thompson NR, Griffith SD, Baldessarini RJ, et al. Comparison of electronic screening for suicidal risk with the Patient Health Questionnaire Item 9 and the Columbia Suicide Severity Rating Scale in an outpatient psychiatric clinic. Psychosomatics. 2015;56(5):460–9.  https://doi.org/10.1016/j.psym.2015.04.005.CrossRefPubMedGoogle Scholar
  20. 20.
    Katzan IL, Viguera AC, Burke T, Buchanan J, Posner K. Improving suicide screening at the Cleveland Clinic through electronic self-reports: PHQ-9 and the Columbia-Suicide Severity Rating Scale (C-SSRS). Poster session presented at: The International Academy of Suicide Research 2013 World congress on suicide; 2013 Jun 10–13; Montreal, Canada.Google Scholar
  21. 21.
    Mundt JC, Greist JH, Jefferson JW, Federico M, Mann JJ, Posner K. Prediction of suicidal behavior in clinical research by lifetime suicidal ideation and behavior ascertained by the electronic Columbia-Suicide Severity Rating Scale. J Clin Psychiatry. 2013;74(9):887–93.  https://doi.org/10.4088/JCP.13m08398.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Arias SA, Zhang Z, Hillerns C, Sullivan AF, Boudreaux ED, Miller I, et al. Using structured telephone follow-up assessments to improve suicide-related adverse event detection. Suicide Life Threat Behav. 2014;44(5):537–47.  https://doi.org/10.1111/sltb.12088.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Wintersteen MB. Standardized screening for suicidal adolescents in primary care. Pediatrics. 2010;125(5):938–44.  https://doi.org/10.1542/peds.2009-2458.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Sudak D, Roy A, Sudak H, Lipschitz A, Maltsberger J, Hendin H. Deficiencies in suicide training in primary care specialties: a survey of training directors. Acad Psychiatry. 2007;31(5):345–9.  https://doi.org/10.1176/appi.ap.31.5.345.CrossRefPubMedGoogle Scholar
  25. 25.
    Hooper LM, Epstein SA, Weinfurt KP, DeCoster J, Qu L, Hannah NJ. Predictors of primary care physicians’ self-reported intention to conduct suicide risk assessments. J Behav Health Serv Res. 2012;39(2):103–15.  https://doi.org/10.1007/s11414-011-9268-5.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Feldman MD, Franks P, Duberstein PR, Vannoy S, Epstein R, Kravitz RL. Let’s not talk about it: suicide inquiry in primary care. Ann Fam Med. 2007;5(5):412–8.  https://doi.org/10.1370/afm.719.CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Vannoy SD, Robins LS. Suicide-related discussions with depressed primary care patients in the USA: gender and quality gaps. A mixed methods analysis. BMJ Open. 2011;1(2):e000198.  https://doi.org/10.1136/bmjopen-2011-000198.CrossRefPubMedCentralPubMedGoogle Scholar
  28. 28.
    Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS). 2014. http://www.cdc.gov/injury/wisqars/index.html. Accessed 25 Nov 2016.
  29. 29.
    Graham RD, Rudd MD, Bryan CJ. Primary care providers’ views regarding assessing and treating suicidal patients. Suicide Life Threat Behav. 2011;41(6):614–23.  https://doi.org/10.1111/j.1943-278X.2011.00058.x.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Dazzi T, Gribble R, Wessely S, Fear NT. Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychol Med. 2014;44(16):3361–3.  https://doi.org/10.1017/S0033291714001299.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    US Food and Drug Administration. Revision to product labeling. 2007. http://www.fda.gov/downloads/drugs/drugsafety/informationbydrugclass/ucm173233.pdf. Accessed 25 Nov 2016.
  32. 32.
    Valuck RJ, Orton HD, Libby AM. Antidepressant discontinuation and risk of suicide attempt: a retrospective, nested case-control study. J Clin Psychiatry. 2009;70(8):1069–77.  https://doi.org/10.4088/JCP.08m04943.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Nutting PA, Dickinson LM, Rubenstein LV, Keeley RD, Smith JL, Elliott CE. Improving detection of suicidal ideation among depressed patients in primary care. Ann Fam Med. 2005;3(6):529–36.  https://doi.org/10.1370/afm.371.CrossRefPubMedCentralPubMedGoogle Scholar
  34. 34.
    Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, et al. Suicide prevention strategies: a systematic review. JAMA. 2005;294(16):2064–74.  https://doi.org/10.1001/jama.294.16.2064.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Robinson PJ, Reiter JT. Behavioral health consultation and primary care: a guide to integrating services. 2nd ed. New York: Springer; 2016.CrossRefGoogle Scholar
  36. 36.
    Hunter CL, Goodie JL. Operational and clinical components for integrated-collaborative behavioral healthcare in the patient-centered medical home. Fam Syst Health. 2010;28(4):308–21.  https://doi.org/10.1037/a0021761.CrossRefPubMedGoogle Scholar
  37. 37.
    Gunn WB, Blount A. Primary care mental health: a new frontier for psychology. J Clin Psychol. 2009;65(3):235–52.  https://doi.org/10.1002/jclp.20499.CrossRefPubMedGoogle Scholar
  38. 38.
    Bryan CJ, Morrow C, Appolonio KK. Impact of behavioral health consultant interventions on patient symptoms and functioning in an integrated family medicine clinic. J Clin Psychol. 2009;65(3):281–93.  https://doi.org/10.1002/jclp.20539.CrossRefPubMedGoogle Scholar
  39. 39.
    Ray-Sannerud BN, Dolan DC, Morrow CE, Corso KA, Kanzler KE, Corso ML, et al. Longitudinal outcomes after brief behavioral health intervention in an integrated primary care clinic. Fam Syst Health. 2012;30(1):60–71.  https://doi.org/10.1037/a0027029.CrossRefPubMedGoogle Scholar
  40. 40.
    Bryan CJ, Corso KA, Corso ML, Kanzler KE, Ray-Sannerud B, Morrow CE. Therapeutic alliance and change in suicidal ideation during treatment in integrated primary care settings. Arch Suicide Res. 2012;16(4):316–23.  https://doi.org/10.1080/13811118.2013.722055.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Serrano N, Monden K. The effect of behavioral health consultation on the care of depression by primary care clinicians. WMJ. 2011;110(3):113–8.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Bryan CJ, Corso KA, Neal-Walden TA, Rudd MD. Managing suicide risk in primary care: practice recommendations for behavioral health consultants. Prof Psychol Res Pr. 2009;40(2):148–55.  https://doi.org/10.1037/a0011141.CrossRefGoogle Scholar
  43. 43.
    Rudd MD. Fluid vulnerability theory: a cognitive approach to understanding the process of acute and chronic suicide risk. In: Elliott CE, editor. Cognition and suicide: theory, research, and therapy. Washington, DC: American Psychological Association; 2006. p. 355–67.CrossRefGoogle Scholar
  44. 44.
    Brown GK, Steer RA, Henriques GR, Beck AT. The internal struggle between the wish to die and the wish to live: a risk factor for suicide. Am J Psychiatry. 2005;162(10):1977–9.  https://doi.org/10.1176/appi.ajp.162.10.1977.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Suresh Kumar PN, George B. Life events, social support, coping strategies, and quality of life in attempted suicide: a case-control study. Indian J Psychiatry. 2013;55(1):46–51.  https://doi.org/10.4103/0019-5545.105504.CrossRefGoogle Scholar
  46. 46.
    Bryan CJ, Corso KA, Macalanda J. An evidence-based approach to managing suicidal patients in patient-centered medical home. Cogn Behav Pract. 2014;21(3):269–81.  https://doi.org/10.1016/j.cbpra.2014.04.006.CrossRefGoogle Scholar
  47. 47.
    Shenassa ED, Rogers ML, Spalding KL, Roberts MB. Safer storage of firearms at home and risk of suicide: a study of protective factors in a nationally representative sample. J Epidemiol Community Health. 2004;58(10):841–8.  https://doi.org/10.1136/jech.2003.017343.CrossRefPubMedCentralPubMedGoogle Scholar
  48. 48.
    Anderson HD, Pace WD, Brandt E, Nielsen RD, Allen RR, Libby AM, et al. Monitoring suicidal patients in primary care using electronic health records. J Am Board Fam Med. 2015;28(1):65–71.  https://doi.org/10.3122/jabfm.2015.01.140181.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Zeidler Schreiter EA, Pandhi N, Fondow M, Fahey L. Access Community Health Centers Integrated Primary Care Consulting Psychiatry Toolkit. 2014. http://www.hipxchange.org/Access. Accessed 25 Nov 2016.
  50. 50.
    Zeidler Schreiter EA, Pandhi N, Fondow MD, Thomas C, Vonk J, Reardon CL, et al. Consulting psychiatry within an integrated primary care model. J Health Care Poor Underserved. 2013;24(4):1522–30.  https://doi.org/10.1353/hpu.2013.0178.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Simon GE, VonKorff M, Rutter C, Wagner E. Randomised trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care. BMJ. 2000;320(7234):550–4.  https://doi.org/10.1136/bmj.320.7234.550.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Alexander D. Smith
    • 1
  • Meghan D. M. Fondow
    • 1
  • Elizabeth A. Zeidler Schreiter
    • 1
  1. 1.Access Community Health CentersMadisonUSA

Personalised recommendations