(180) Educating Internal Medicine Interns about Depression and Suicide Risk Assessment

Abstract:

Background: Primary care providers (PCPs) provide a significant amount of mental health care and can benefit from additional psychiatric training. Given that up to 45% of people who die by suicide saw a PCP within one month of their death, education on identification and management of depressed and suicidal patients is important (Luoma 2002). This medical education intervention is a continuation of a project presented at CLP 2020.

Methods: This project was conducted with 72 internal medicine (IM) interns at the University of Chicago Medicine during the 2019-2020 (AY19, N=34) and 2020-2021 (AY20, N=38) academic years. A case-based lecture focusing on depression and suicide risk assessment was presented during each academic year. A 9-item survey assessing confidence in clinical skills was given at T1 (pre-lecture), T2 (post-lecture), and T3 (6-month follow up). These items were used to create three separate outcomes assessing confidence in assessing depression symptoms, assessing for suicidal ideation (SI), and managing SI. Additionally, participants in AY20 were given a 19-item checklist and asked to identify the symptoms of depression at each time point to assess their knowledge.

Results: A total of 65 participants completed the confidence survey at T1, with 57 responses at T2 and 35 responses at T3. Repeated mixed effect models indicated that participants scored significantly higher at T2 compared to T1 in all three confidence measures ([depression symptoms] t₈₁=5.22, p< 0.001; [SI] t₈₁=6.00, p< 0.001; [SI management] t₈₁=15.22, p< 0.001). At T3, all three confidence measures remained significantly higher compared to T1 ([depression symptoms] t₈₁=3.51, p< 0.001; [SI] t₈₁=3.08, p=0.003; [SI management] t₈₁=4.60 p< 0.001); however, there was a significant drop in confidence with managing SI between T2 and T3 (t₈₁=6.81 p< 0.001). Knowledge of depression symptoms did not change across time, likely due to ceiling effects observed at T1 (F(2,43)=0.55 p=0.58).

Discussion: Significant increases in confidence scores from T1 to T2 and T3 suggest immediate and lasting effects of adding a suicide risk assessment lecture for IM interns. However, the significant decrease between T2 to T3 for confidence in managing SI may indicate the need for a booster session. Overall, a plurality of participants accurately identified all symptoms of depression at all time points; this may indicate that the lecture works to improve confidence in already achieved skills.

Limitations: The curriculum was limited to a single, one-hour lecture given once per year without a clinical component. Knowledge of depression symptoms was only assessed in AY20. The surveys did not assess knowledge questions related to suicide risk assessment or suicide risk factors.

Reference:
Luoma, J. B., Martin, C. E., & Pearson, J. L. Contact with mental health and primary care providers before suicide: A review of the evidence. Am J Psychiatry. 2002;159(6), 909–916.