The prevalence of suicidal ideation and depression among primary care patients and current management in South Korea

BACKGROUND Primary care in South Korea has no effective screening system to identify high-risk suicide patients despite to the possibility of hidden patients. The present study examined the prevalence of suicidal ideation and depression among primary care patients and investigated rates of recognition and management strategies of physicians as they encountering patients with suicidal ideation and depression in primary care settings. METHODS This study was conducted as a two-part survey of patients visiting primary care clinics and their physicians. (1) The survey for patients was administered over 17 days in two areas and assessed socio-demographic characteristics, health behavior and the prevalence of suicidal ideation and depression. The participants were 1363 outpatients; 848 lived in urban area, and 515 were from rural area. (2) We surveyed the physicians' recognition of patients with suicidal ideations and depression as well as their current management. Eighteen doctors at 15 local clinics (8 in urban area and 7 in rural area) participated in this survey. RESULTS The prevalence rates of suicidal ideation and depression (Patient Health Questionnaire-9 ≥ 10) were 18.3% (95% confidence interval: 16.2-20.3) and 13.9% (95% CI 12.6-15.7), respectively in primary care settings. The rates of suicidal ideation and depression were approximately 2.4 times and 1.4 times higher, respectively than those in community dwelling people. Ten (69.7%) and 4 (26.7%) of the 15 clinics staffed physicians who did not recognize suicidal ideation and depression, respectively. Five (83.3%) of 6 and 4 (38.6%) of 14 physicians who recognized suicidal ideation and depression among their patients respectively, only recommended psychiatry without any arrangements for a referral. CONCLUSION Our findings imply that many patients with suicidal ideations and depression in primary care settings are under-diagnosed and under-treated. As a result, education and training of the identification and management of suicidal ideation and depression should be made available to physicians in primary care settings.