Major Depressive Disorder, Suicides, and the Role of Dimensional Psychiatry for Triaging in Primary Care Settings: A Case Series Retroanalysis.

Objective: The goal was to promote early diagnosis and referral of patients with depressive symptomology in the primary care setting using a biopsychosocial-informed risk stratification tool to prevent suicides. Methods: A qualitative analysis of military suicides stationed at Fort Eustis, Virginia, using demographics from Fatality Review Boards (FRBs) of 10 cases assessing shared biopsychosocial stressors was conducted. The case reviews were used to assess the failure modes and effects analyses (FMEA), prompting the development of a performance improvement (PI) plan via a risk stratification scale that recognizes opportunities for intervention in the primary care and supervisor/peer settings to improve patient outcomes. Results: FMEA revealed the presence and interplay of multiple biopsychosocial stressors specifically impacting relationships, occupational functioning, financial status, legal issues, and undiagnosed mental health conditions across the 10 suicides reviewed. Furthermore, the severity of each stressor was best examined from a dimensional perspective to gauge the impact on or impairment of the individual in the military setting. The dimensional use of biopsychosocial stressors is congruent with our hypothesis that an increase in duration and intensity of biopsychosocial stressors increases risk of suicide. Conclusion: This case series reveals a gap in suicide assessment and suggests the use of a dimensional approach to measure biopsychosocial stressors at the entry level, such as primary care settings, or in the case of the military, during routine counseling. Additionally, a risk stratification tool that crosses biopsychosocial domains could provide a more accurate assessment for self-harm, in turn enabling a timely referral to appropriate helping agencies, including nonclinical resources.