Table A1.
Simulated patient cases scenarios.
| Case Number (Year) | Case 1 (2016) | Case 2 (2016) | Case 3 (2017) | Case 4 (2017) | Case 5 (2018) | Case 6 (2018) |
|---|---|---|---|---|---|---|
| Topic | Depressive symptoms without suicidal thoughts. | Depressive symptoms with suicidal thoughts. | Depressive symptoms with suicidal thoughts. | Anxiety/depressive symptoms without suicidal thoughts. | Depressive symptoms with suicidal thoughts. | Anxiety/depressive symptoms with suicidal thoughts. |
| Reason for pharmacy visit | Feeling depressed for the past two months. | Request to fill antidepressant repeat. | Request multivitamin for energy. | Request sleeping tablet for insomnia. | Request multivitamin for energy. | Request to fill antidepressant repeat. |
| Symptoms | Teary and stressed. Severe sleep deprivation (first baby, three months old, unable to sleep for more than half an hour). |
Deteriorating mood for the past two months after taking antidepressant (fluoxetine). Stopped taking fluoxetine a few days ago. Poor appetite. Little motivation for daily activities. |
Flat and lethargic since recent divorce. Unable to get out of bed in the morning. Little motivation to work. |
Insomnia. | Flat and lethargic. Low energy to get out of bed in the morning. Little motivation to go to work. |
Feeling worse over the past few weeks and questioning whether life is worth it. Low motivation for self-care. Poor appetite. |
| Medical history | Previous depression diagnosis at 21. History of antidepressant use & psychotherapy. |
Recent diagnosis of depression. Doctor prescribed fluoxetine last month to help with the mood. |
No significant medical history. | Had panic attacks as a teenager. | History of depression in early 20s. Went through psychological therapy for months. |
Citalopram for anxiety disorder for years. |
| Social history | New immigrant from America. Social isolation. Little support from partner (at work). |
Recent financial struggles due to job cuts three months ago. Social isolation (partner at work; two daughters have moved out). |
Divorced three months ago.Close to sister. | Has two young children (12 months and 22 months). Supportive parents and partner (working two jobs). |
Recent divorce. Closer to sister. |
Recent financial issues (house). Recent loss of employment (isolation). Supportive partner but rarely home (work). |
| Suicidal thoughts | No. | Current suicidal thoughts with no current plan. No previous attempt. |
Current suicidal thoughts with no current plan. No previous attempt. |
No. | Current suicidal thoughts with plan (considers jumping off the balcony). No previous attempt. |
Current suicidal thoughts with plan (taking all citalopram at once). |
| Alcohol/drug use | ½ bottle of red wine each night. | Taking sleeping tablets (doxylamine) every night. A whole bottle of wine on some nights. |
Recent increase of alcohol intake | 1–2 glasses of wine each night. | Recent increase of alcohol intake (one bottle of wine per night). | Taking sleeping tablets (doxylamine) every night. Recent increase in alcohol intake (2–3 of partner’s beers every day). |
| Says | “I can’t do this anymore”, “My baby would be better off without me.” | “Everyone would be better off without me. I don’t see a point in living anymore.” | “I just feel like it’s not worth it anymore”, “There’s no point in life.” | “It’s just too hard”, “I don’t know if I can keep doing this.” | “I just feel like it’s not worth it anymore”, “There’s no point in life.” | “Everyone would be better off without me. I don’t see a point in living anymore.” |