Discussing Suicide With Maria Oquendo, MD, APA President-Elect

ATLANTA, Georgia — During the opening session of the 169^th Annual Meeting of the American Psychiatric Association, attendees were introduced to the President-Elect, Maria Oquendo, MD, Vice Chair for Education and Director of Residency Training at the New York State Psychiatric Institute of Columbia University. Dr Oquendo has recently been appointed Chair of the Department of Psychiatry in the Perelman School of Medicine at the University of Pennsylvania and will begin her new role on January 1, 2017.

Dr Oquendo met with Psychiatry Advisor to discuss current and future research, as well as her plans for the direction of the organization.

Psychiatry Advisor:  Dr Oquendo, you identify a main goal for the association as being a focus on preventing and effectively treating mental illness, particularly suicide.  How did you identify this as your priority?

Maria Oquendo, MD:  I have been interested in suicide prevention for a very long time, and most of my research has been focused on suicidal behavior. However, although this is a goal that has been long pursued by many, it remains quite elusive.  We are aware that there are things that happen in childhood and adolescence that can predispose individuals to suicidal behavior.  Indeed, as we learn more about the antecedents to psychiatric conditions, we see that many of them have roots in childhood and adolescence.  Of course, we know that these conditions are heritable and genetic and, to date, there is not much we can do about that. But we also know that not everybody will inherit the propensity for suicidality; even with identical twins, you don’t have 100% concordance. Therefore, influence of the environment is obviously very important.  Identifying environmental factors that put people at risk for suicidal behavior has always been of significant interest to me.

Another personal focus is to encourage the collaboration between medical and psychiatric professionals.  There are individuals who might have subthreshold symptoms and may not yet meet criteria for a diagnosis, but those individuals obviously are at risk of developing certain conditions.  In addition, the symptoms themselves can cause significant suffering.  The concept is that if we as psychiatrists can partner with other specialties—and also engage physician extenders to help with this—then we can start to address symptoms and suffering before a full-blown disorder is diagnosed or developed.

Psychiatry Advisor:  What do you see as being the role of the psychiatrist in this collaborative care model, and what are the challenges of integrating primary care with behavioral and mental health prevention and treatment?

Dr Oquendo:  Interestingly, there has been a tremendous amount of work elaborating on these integrated care models.   In the most popular one, the psychiatrist is embedded in the primary care clinic as part of the team.  They work with physicians, nurse practitioners, physician assistants, and case workers to implement routine screening for common mental health disorders such as substance abuse, anxiety disorders, and depression.  Just as patients are assessed for conditions such as hypertension and diabetes so too can patients be screened for potential mental disorders.  In fact, there are validated instruments that can easily be delivered in a kiosk or completed by a patient on a tablet. The patient can then be flagged for intervention if they are symptomatic.  The idea is that the psychiatrist supervises the physician extenders who monitor and treat routine types of conditions, which then allows the psychiatrist the ability to manage those with more treatment-refractory or complex cases.  This model implies that one person cannot take care of the entire population served by one clinic or medical service.  You really need a team of providers to be able to reach all of the individuals within the medical practice who may require intervention.