[Suicide prevention by the general practitioner].

Abstract

Although suicides in Germany are on the decrease, for the care-providing physician a suicidal patient must always be considered an emergency. An elevated risk is to be seen above all in patients with psychological/mental problems, in particular those suffering from depression, but also those experiencing a crisis associated with ageing, physical illnesses or intolerable social situations. A range of factors may influence suicidal behavior, such as the specific situation of the patient or the loss of protective factors. When his/her coping strategies or outside help then fails, a triggering event may prompt suicide. As a rule, the suicide-endangered patient goes through three stages--a period of weighing up, ambivalence and decision-taking. For the care-providing physician it is of particular importance to recognize the ambivalence stage in good time, for it is here that the patient gives expression to thoughts of suicide and the physician has an opportunity to intervene. Major preventive measures are the build-up of a doctor-patient relationship and a readiness to "talk things through". Further crisis management includes, for example, the use of psychopharmaceuticals or the initiation of psychotherapy.