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Major depression with suicide risk — RACGP Fellowship MCQ

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HardMental healthMajor depression with suicide riskRACGP Fellowship

A 42‑year‑old man presents with low mood, early‑morning waking and guilt for two months. He reports daily alcohol use of eight standard drinks and passive thoughts that his family would be better off without him, although he has no active plan. His PHQ‑9 score is 21. What is the most appropriate management?

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Reveal the answer and explanation

Correct answer: D — Conduct structured suicide risk assessment, safety planning and initiate active treatment with close follow‑up

Explanation lettering: C = shown as A · A = shown as C

The patient presents with moderate‑to‑severe depression (PHQ‑9=21), melancholic symptoms (early waking, guilt), heavy alcohol use and passive suicidal ideation—all of which elevate his risk for suicide even without a clear plan. According to Australian GP guidance, such presentations require a formal suicide risk assessment, formulation of a safety plan, and commencement of active treatment with close follow‑up (Option D) ([mentalhealth.racgp.org.au](https://mentalhealth.racgp.org.au/guidelines/index/3196c496-3a69-4179-aaa9-97b23d17bb1e?utm_source=openai)). Lifestyle advice alone (A) is insufficient. Starting antidepressants without further suicide enquiry (B) omits critical safety steps. Abrupt home alcohol cessation (C) risks withdrawal harm. Delaying review by months (E) is unsafe given acuity.

Reference: RACGP guidelines: “Suicide prevention – Risk assessment in general practice” and “Suicide risk factors” (GPMHSC, recent) – direct Australian primary care guidance supporting need for structured assessment, safety planning and active management. https://mentalhealth.racgp.org.au/guidelines/index/3196c496-3a69-4179-aaa9-97b23d17bb1e