Nudging General Practitioners to explore suicidal thoughts among depressed patients

Elke Elzinga; Derek P de Beurs; Aartjan T F Beekman; Otto R Maarsingh; Renske Gilissen

doi:10.1186/s12875-023-02043-3

Nudging General Practitioners to explore suicidal thoughts among depressed patients

BMC Prim Care. 2023 Apr 1;24(1):88. doi: 10.1186/s12875-023-02043-3.

Authors

Elke Elzinga^{1

2}, Derek P de Beurs³, Aartjan T F Beekman^{4

5}, Otto R Maarsingh⁶, Renske Gilissen⁷

Affiliations

¹ 113 Suicide prevention, research department, Paasheuvelweg 25, Amsterdam, 1105 BP, the Netherlands. e.elzinga@113.nl.
² Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands. e.elzinga@113.nl.
³ Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
⁴ Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
⁵ Department of Research & Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands.
⁶ Department of General Practice, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
⁷ 113 Suicide prevention, research department, Paasheuvelweg 25, Amsterdam, 1105 BP, the Netherlands.

Abstract

Background: While frank discussion of suicidal thoughts in patients with depression is important for the prevention of suicide, suicide exploration of General Practitioners (GPs) is suboptimal. This study aimed to assess whether an intervention that prompts pop-up screens nudges GPs to more frequently explore suicidal thoughts over the course of two years.

Methods: From January 2017 to December 2018, the intervention was incorporated in the information system of the Dutch general practice sentinel network. New registration of an episode of depression triggered a pop-up screen referring to a questionnaire about GPs' behaviour with regard to exploring suicidal thoughts. In two years, 625 questionnaires were completed by GPs and analysed using multilevel logistic regression analyses.

Results: Compared to the first year, GPs were 50% more likely to explore suicidal thoughts among patients in the second year (OR 1.48; 95%CI 1.01-2.16). When adjusting for patients' gender and age we found that the effect of the pop-up screens disappeared (OR 1.33; 95% CI 0.90-1.97). Suicide exploration occurred less frequently in women than in men (OR 0.64; 95% CI 0.43-0.98) and in older compared to younger patients (OR 0.97; 95% CI 0.96-0.98 per year older). In addition, 26% of variation in suicide exploration was because of differences in general practice. There was no evidence that general practices developed differently over time.

Conclusions: Although low cost and easy to administer, the pop-up system was not effective in nudging GPs to explore suicidality more frequently. We encourage studies to test whether implementing these nudges as part of a multifaceted approach will lead to a stronger effect. Moreover, we recommend researchers to include more variables, such as work experience or previous mental health training, to better understand the effects of the intervention on GPs' behaviour.

Keywords: Behaviour change; Clinical guidelines.; Depression; General practice; General practitioners; Intervention; Mental health; Nudging; Suicide exploration; Suicide prevention.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Family Practice
Female
General Practice*
General Practitioners* / psychology
Humans
Male
Suicidal Ideation
Suicide* / psychology