Stress is a significant contributor to suicide ideation and attempts. This paper (1) describes the frequency of clinic visits in which physicians record stress management counseling; and (2) identifies visit-, physician-, and patient-related predictors of stress management counseling. We conducted a secondary analysis of the 2018 and 2019 National Ambulatory Medical Care Survey (NAMCS) clinic visit datasets. We identified clinic-, patient-, and physician-related predictors of stress management counseling. All analyses used weighted adjustment to account for the complex survey design. The weighted sample included 1,495,326,615 visits (unweighted (n=14,175) in 2018-2019. Combined, 1.32 per 100 visits (95% CI=0.72-1.92) included stress management counseling. Stress management counseling was less likely to occur when the visit occurred in a rural area (OR=0.22, 95% CI=0.09-0.53), among other characteristics. Stress management counseling rarely occurs during physician office visits in rural areas, despite rural areas suffering disproportionately worse health outcomes than urban areas.

The authors have declared no competing interest.

This study did not receive any funding.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

NAMCS data are available to the public and are completely de-identified.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data produced are available upon reasonable request to the authors.