What are Canadian emergency physicians' attitudes and self-perceived competence toward patients who present with suicidal ideation?

Clinician Attitudes Toward Suicide Prevention Practices and Their Implementation: Findings From the System of Safety Study

OBJECTIVE

The authors aimed to assess clinicians' attitudes toward suicide-related practices and their implementation, across roles and settings, before implementation of the Zero Suicide model in a health care system.

METHODS

Clinicians (N=5,559) were invited to complete a survey assessing demographic characteristics; confidence and self-reported suicide-related practice; leadership buy-in; and attitudes toward suicide prevention, safety planning, and continuous quality improvement (CQI).

RESULTS

Of 1,224 respondents, most felt confident conducting suicide screening but less confident performing other suicide-related care. Provider role and care setting were significantly associated with confidence (p<0.001, Kruskal-Wallis H test) and practice (p<0.001, Kruskal-Wallis H test) of providing suicide prevention care, with behavioral health providers and providers in the emergency department (ED) reporting the highest confidence. Attitudes toward safety planning were more positive among women (p<0.001, t test) and behavioral health providers (p<0.001, F test) than among their counterparts or peers. Positive attitudes toward CQI were significantly associated with male sex (p=0.01), non-White race (p=0.03), younger age (p=0.02), fewer years working in health care (p<0.001), administrative role (p<0.001), working in the ED (p<0.001), outpatient settings (p<0.02), and medical provider role (p<0.001).

CONCLUSIONS

Behavioral health providers and those in the ED reported feeling prepared to deliver suicide-related care, with nurses feeling less confident and less supported. Initiatives to improve suicide-related care should account for clinical role and care setting during planning. CQI could help engage a broader range of clinicians in suicide-related care improvements.

Examination of medical student and physician attitudes towards suicide reveals need for required training

The attitudes of healthcare providers towards suicidal patients are known to influence their motivation to treat patients during a suicidal crisis. Patients who attempted suicide are more likely to have recently visited a primary care provider who is not necessarily sufficiently trained in managing a suicidal patient rather than a mental health provider who is trained to do so. For those reasons, documenting medical students and physicians' attitudes towards suicide can help in the development of effective intervention training to prepare them to manage these types of patients. In this mini review, attitudes towards suicidal patients, the effectiveness of training on changing their attitudes are discussed. In summary, primary care providers are recognized as a top area where improvements can prevent suicides; providing proper suicide prevention training can effectively improve attitudes and quality of care for suicidal patients.

Experiences of care for self-harm in the emergency department: the perspectives of patients, carers and practitioners

Emergency departments are often the point of entry to the healthcare system for people who self-harm, and these individuals are at high risk of further self-harm and suicide in the post-discharge period. These settings therefore provide a critical opportunity for intervention. However, many studies have identified that the experiences of patients, carers and the emergency department staff themselves is often suboptimal. In this editorial we summarise one such study, by O'Keeffe and colleagues, and consider strategies for improving the experiences of patients and their carers when presenting to the emergency department. We also reiterate the need for wider systemic change in attitudes and approaches towards people who self-harm that are pervasive across the healthcare system and beyond.

Professional Care Experiences of Persons With Suicidal Ideation and Behavior: Model Development Based on a Qualitative Meta-Synthesis

BACKGROUND

Health care professionals (HCPs) are challenged in caring for persons with suicidal ideation or behavior. For affected persons, professional care is essential, and being interviewed about their experiences can be stressful. The experiences of persons ideating or attempting suicide are essential to designing eHealth products to support them in crises and provide continuous care.

OBJECTIVE

This study aimed to synthesize published qualitative research about how persons with suicidal thoughts or behavior experience inpatient or outpatient care. A model will be derived from the meta-synthesis to guide HCPs in their work with affected persons and provide a thorough needs assessment for eHealth development.

METHODS

A qualitative meta-synthesis was conducted using an inductive approach, as proposed by Sandelowski and Barroso. The inclusion criteria were studies in English and German that dealt with persons who ideated or attempted suicide. Relevant articles were identified by searching the PubMed and Cinahl databases and by hand searching relevant journals and reference lists. The findings of each study were analyzed using initial and axial coding, followed by selective coding. Finally, a conceptual model was derived.

RESULTS

In total, 3170 articles were identified in the systematic literature search. Articles were screened independently by 2 researchers based on the eligibility criteria. Finally, 12 studies were included. The central phenomenon observed among persons ideating or attempting suicide is their process from feeling unanchored to feeling anchored in life again. During inpatient and outpatient care, they experience being dependent on the skills and attitudes of HCPs. While helpful skills and attitudes support persons ideating or attempting suicide to reach their feeling of being anchored in life again, adverse interactions are experienced negatively and might lead to prolonging or maintaining the feeling of being unanchored in life.

CONCLUSIONS

The study promotes a differentiated view of the experiences of persons ideating or attempting suicide. The derived conceptual model can guide HCPs in their work with affected persons to support affected persons during their recovery. Moreover, the conceptual model is useable as a springboard to develop eHealth solutions for crisis situations and long-term care.