PCP Opinions of Universal Suicide Risk Screening in Rural Primary Care: Current Challenges and Strategies for Successful Implementation

• Published in: The Journal of rural health Vol. 37; no. 3; pp. 554 - 564
• Main Authors: LeCloux, Mary, Aguinaldo, Laika D., Lanzillo, Elizabeth C., Horowitz, Lisa M.
• Format: Journal Article
• Language: English
• Published: Washington Wiley Subscription Services, Inc 01.06.2021
• Subjects: Access; Barriers; Coders; Cultural values; Discomfort; Efficacy; Feasibility; Health behavior; Health care; Health care industry; Health problems; integrated behavioral health; Medical personnel; Medical screening; Medicine; Mental health; Mental health services; Multidisciplinary teams; Patients; Primary care; Professionals; Risk assessment; Risk behavior; Risk taking; Rural areas; rural medical settings; Strategies; Suicide; suicide prevention; suicide risk screening; Suicides & suicide attempts; Support services; Technology; Tests; Training
• ISSN: 0890-765X; 1748-0361
• DOI: 10.1111/jrh.12508

Purpose Universal suicide risk screening has the potential to address the disproportionately high rates of suicide in the rural United States, as 83% of people who have died by suicide have visited a health care provider in the year prior to their deaths, and rural patients are more likely to visit medical professionals than behavioral health professionals for mental health concerns. This study describes the opinions of primary care providers (PCPs) practicing in a primarily rural state regarding universal suicide risk screening, barriers to implementation, and strategies to increase the feasibility of screening in their practices. Methods In‐depth, individual semistructured qualitative interviews were conducted with a sample of PCPs practicing in West Virginia (N = 15). Applied thematic analysis of the data was completed by a team of 3 coders using a consensus‐coding methodology. Findings The majority of PCPs supported the practice of screening, but they identified multiple barriers, including a lack of access to mental health and crisis support services, concerns about clinic flow and follow‐up with suicidal patients, cultural beliefs specific to rural Appalachia, and provider discomfort with screening. Strategies suggested to address these barriers included the use of technology for screening, a multidisciplinary team approach, streamlined methods for screening and risk assessment, co‐located behavioral health, and additional trainings for PCPs on the topic of suicide. Conclusion Future research should examine the efficacy of universal suicide risk screening programs in rural adult primary care that utilize these strategies in diverse samples with longitudinal data.