WITHDRAWN: Universal Suicide Risk Screening in Rural Primary Care: The Reports of West Virginia Primary Care Providers

Introduction: Rural areas of the U.S. have disproportionately high suicide rates compared to more urban areas (CDC, 2017). The majority of people who die from suicide have seen a primary care provider in the months prior to their death (Ahmedani et al., 2014), and the Joint Commission (2016) has recommended suicide risk screening for all medical patients. However, only between 11-36% of primary care providers routinely screen for suicidality in their patients (Diamond et al., 2012; Feldman et al., 2007; Hooper et al., 2012). The purpose of the present study was to interview a sample of rural primary care providers regarding their current suicide risk screening practices, identify barriers to screening and obtain suggestions for improving feasibility.

Methods: Primary care providers were contacted via phone and emailed by primary care agencies throughout the state of West Virginia. Multidisciplinary groups were approached including Doctors of Medicine (MD’s), physician assistants (PA’S), Advanced Practice Registered Nurses (APRN), and Doctor of Osteopathy (DO). Participants were asked to fill out a brief demographics questionnaire and participate in a 30-45 minute, in-depth qualitative interview that was tape-recorded. Interviews were transcribed verbatim and coded thematically with N’Vivo by a team of three coders. A consensus coding methodology was utilized.

Results: A convenience sample of 15 providers were enrolled. All providers (100%) identified as White, and 53% were female. The majority (11) were Doctors of Medicine (MD’s), 2 were physician assistants (PA’S), 1 was an Advanced Practice Registered Nurses (APRN), and 1 was a Doctor of Osteopathy (DO). While 10 out of the 15 providers reported screening universally for depression, only 2 reported screening universally for suicide. The majority of providers (n = 14) noted the importance of suicide risk screening, however multiple barriers to screening were identified, including: time management concerns and the lack of crisis support and mental health resources, competing multiple screening burdens, concerns about patient reactions, and provider discomfort with the topic of suicide. Providers suggested interventions for improving feasibility such as: streamlined guidelines for suicide risk assessment, greater use of technology and integrating screening for mental health and medical issues.

Conclusions: While many providers note the importance of suicide risk screening, more supports and guidelines are needed to improve feasibility within rural primary care. Use of technology, streamlining guidelines for screening, and providing more training and support for providers regarding the topic of suicide are some potential interventions that may increase suicide risk detection in primary care settings.