Prevention of suicidal behavior in diabetes: the role of primary care COMMENT

Studies in different countries suggest that the rates of suicide ideation, attempts and death are increased in patients with diabetes in comparison to the general population. Suicidal behavior in patients with diabetes is a significant but underappreciated problem. Elevated suicide risk in individuals with diabetes may be related to comorbid psychiatric disorders, particularly depression. Considerable evidence suggests a bidirectional relationship between diabetes and depression: individuals with diabetes are at elevated risk of developing depression and patients with depression are more likely to develop diabetes. Frequent comorbidity of diabetes and depression may be related to psychosocial and neurobiological factors. Other comorbid psychiatric conditions including anxiety and alcohol use disorders may also increase suicide risk in diabetes. Primary care physicians are likely the key to suicide prevention efforts in individuals with diabetes since they see almost half of individuals who die by suicide within 1 month of their suicide. The management of potentially suicidal patients with diabetes in primary care comprises six major components: management of diabetes and its complications, especially conditions associated with pain; diagnosis and treatment of comorbid psychiatric disorders; frequent assessment of suicide risk; restricting access to the means of suicide; specific treatments to reduce the predisposition to attempt suicide; and referral to psychiatric care. Suicide prevention in individuals with diabetes and other medical disorders is a difficult but critically important task.