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Saini P, Hunt A, Blaney P, Murray A. Recognising and Responding to Suicide-Risk Factors in Primary Care: A Scoping Review. JOURNAL OF PREVENTION (2022) 2024:10.1007/s10935-024-00783-1. [PMID: 38801507 DOI: 10.1007/s10935-024-00783-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
The cost of one suicide is estimated to be £1.67 million (2 million euros) to the UK economy. Most people who die by suicide have seen a primary care practitioner (PCP) in the year prior to death. PCPs could aim to intervene before suicidal behaviours arise by addressing suicide-risk factors noted in primary care consultations, thereby preventing suicide and promoting health and wellbeing. This study aimed to conduct a rapid, systematic scoping review to explore how PCPs can effectively recognise and respond to suicide-risk factors. MedLine, CINAHL, PsycINFO, Web of Science and Cochrane Library databases were searched for three key concepts: suicide prevention, mental health and primary care. Two reviewers screened titles, abstracts and full papers independently against the eligibility criteria. Data synthesis was achieved by extracting and analysing study characteristics and findings. Forty-two studies met the eligibility criteria and were cited in this scoping review. Studies were published between 1990 and 2020 and were of good methodological quality. Six themes regarding suicide risk assessment in primary care were identified: Primary care consultations prior to suicide; Reasons for non-disclosure of suicidal behaviour; Screening for suicide risk; Training for primary care staff; Use of language by primary care staff; and, Difference in referral pathways from general practitioners or primary care practitioners. This review focused on better recognition and response to specific suicide-risk factors more widely such as poor mental health, substance misuse and long-term physical health conditions. Primary care is well placed to address the range of suicide-risk factors including biological, physical-health, psychological and socio-economic factors and therefore these findings could inform the development of person-centred approaches to be used in primary care.
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Affiliation(s)
- Pooja Saini
- School of Psychology, Faculty of Health, Suicide and Self-Harm Prevention, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK.
| | - Anna Hunt
- School of Psychology, Faculty of Health, Suicide and Self-Harm Prevention, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Peter Blaney
- School of Psychology, Faculty of Health, Suicide and Self-Harm Prevention, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Annie Murray
- Department of Health and Social Care, Office for Health Improvement and Disparities, Piccadilly Place 3, Manchester, M1 3BN, UK
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Dudeney E, Coates R, Ayers S, McCabe R. Acceptability and content validity of suicidality screening items: a qualitative study with perinatal women. Front Psychiatry 2024; 15:1359076. [PMID: 38666087 PMCID: PMC11044181 DOI: 10.3389/fpsyt.2024.1359076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Background Suicide is a leading cause of death for perinatal women. It is estimated that up to 50% of women with mental health issues during pregnancy and/or after birth are not identified, despite regular contact with healthcare services. Screening items are one way in which perinatal women needing support could be identified. However, research examining the content validity and acceptability of suicide-related screening items with perinatal women is limited. Aims This study sought to: (i) assess the acceptability and content validity of 16 suicide-related items that have been administered and/or validated in perinatal populations; and (ii) explore the potential barriers and facilitators that may affect how women respond to these items when administered during pregnancy and after birth. Methods Twenty-one cognitive and semi-structured interviews were conducted with pregnant and postnatal women in the UK. The sample included women who had experienced self-reported mental health problems and/or suicidality during the perinatal period, and those who had not. Interviews were transcribed verbatim, and a coding framework based on the Theoretical Framework of Acceptability was applied to explore the data using deductive and inductive approaches. Results Findings indicated that the acceptability and content validity of suicide-related items were largely unacceptable to perinatal women in their current form. Women found terms such as 'better off dead' or 'killing myself' uncomfortable. Most women preferred the phrase 'ending your life' as this felt less confronting. Comprehensibility was also problematic. Many women did not interpret 'harming myself' to include suicidality, nor did they feel that abstract language such as 'leave this world' was direct enough in relation to suicide. Stigma, fear, and shame was central to non-disclosure. Response options and recall periods further affected the content validity of items, which created additional barriers for identifying those needing support. Conclusions Existing suicide-related screening items may not be acceptable to perinatal women. Maternity practitioners and researchers should consider the phrasing, clarity, context, and framing of screening items when discussing suicidality with perinatal women to ensure potential barriers are not being reinforced. The development of specific suicidality screening measures that are acceptable, appropriate, and relevant to perinatal women are warranted.
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Affiliation(s)
- Elizabeth Dudeney
- Centre for Maternal and Child Health Research, School of Heath and Psychological Sciences, City, University of London, London, United Kingdom
| | - Rose Coates
- Centre for Maternal and Child Health Research, School of Heath and Psychological Sciences, City, University of London, London, United Kingdom
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Heath and Psychological Sciences, City, University of London, London, United Kingdom
| | - Rose McCabe
- Centre for Mental Health Research, School of Heath and Psychological Sciences, City, University of London, London, United Kingdom
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Pompili M. On mental pain and suicide risk in modern psychiatry. Ann Gen Psychiatry 2024; 23:6. [PMID: 38229110 PMCID: PMC10790486 DOI: 10.1186/s12991-024-00490-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/04/2024] [Indexed: 01/18/2024] Open
Abstract
Facing suicide risk is probably the most difficult task for clinicians when dealing with patients in crisis. It requires professional, intellectual, and emotional efforts. Suicide risk assessment can sometimes be distressing for clinicians, and such a state may favour the avoidance of an in-depth exploration of suicidal thoughts and behaviour. Patients often feel subjected to interpersonal assessments with little opportunity to explore their perspectives. The "One size fits all" approach tends to create distance and paradoxically contributes to an increase in the risk of suicide. Traditional clinical factors may be of limited value if a shared understanding of the patient's suicide risk is missed. To understand the suicidal mind, it is necessary to take the point of view of the subject in crisis. In this essay, the "operational model of mental pain as a main ingredient of suicide" provided by Edwin Shneidman' is overviewed with the aim of a better empathic understanding of patients' sufferance. With a phenomenological approach, the suicidal crisis appears as a complex, pervasive state rather than as a symptom of a mental disorder, as the new paradigm also suggests. In this regard, the "mentalistic" aspects of suicide propose a broader insight into the suicidal scenario far beyond the diagnosis of psychiatric disorders. In this article, the perspective of individuals who deem their mental pain to be intolerable is described to make sense of their ambivalence between the wish to die and the wish to live that can prevail if relief is provided.
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Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
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Bergen C, Bortolotti L, Temple RK, Fadashe C, Lee C, Lim M, McCabe R. Implying implausibility and undermining versus accepting peoples' experiences of suicidal ideation and self-harm in Emergency Department psychosocial assessments. Front Psychiatry 2023; 14:1197512. [PMID: 37711424 PMCID: PMC10499316 DOI: 10.3389/fpsyt.2023.1197512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/01/2023] [Indexed: 09/16/2023] Open
Abstract
Background Patients seeking emergency care for self-harm and suicidality report varying experiences from being believed and taken seriously to not being believed and taken seriously. Epistemic injustice provides a conceptual framework to explore how peoples' experiences of self-harm and suicidality are believed or not. We use an empirical method -conversation analysis - to analyze epistemics in clinical communication, focusing on how knowledge is claimed, contested and negotiated. In courtroom, police and political interaction, conversation analysis has identified communication practices implying implausibility in a person's story to contest and recharacterize their accounts. Aims To investigate communication practices in Emergency Department (ED) biopsychosocial assessments that may (1) undermine, imply implausibility and recharacterize or (2) accept peoples' experiences of suicidal ideation and self-harm. Methods Using conversation analysis, we micro-analyzed verbal and non-verbal communication in five video-recorded biopsychosocial assessments with people presenting to the ED with self-harm or suicidal ideation, and conducted supplementary analysis of participants' medical records and post-visit interviews. We present three cases where experiences were not accepted and undermined/recharacterized and two cases where experiences were accepted and validated. Results When peoples' experiences of suicidality and self-harm were not accepted or were undermined, questioners: did not acknowledge or accept the person's account; asked questions that implied inconsistency or implausibility ("Didn't you tell your GP that you were coping okay?"); juxtaposed contrasting information to undermine the person's account ("You said you were coping okay before, and now you're saying you feel suicidal"); asked questions asserting that, e.g., asking for help implied they were not intending to end their life ("So when you called 111 what were you expecting them to do"); and resistinged or directly questioned the person's account. Multiple practices across the assessment built on each other to assert that the person was not suicidal, did not look or act like they were suicidal; that the person's decision to attend the ED was not justified; that an overdose was impulsive and not intended to end life; asking why the person didn't take a more harmful medication to overdose; that self-harming behaviors were not that serious and should be in the person's control. Alternative characterizations were used to justify decisions not to provide further support or referrals to specialist services. At times, these practices were also delivered when speaking over the patient. When peoples' experiences were accepted, practitioners acknowledged, accepted, validated suicidality/self-harm and introduced a shared understanding of experiences that patients found helpful. Non-verbal feedback such as nodding and eye contact was central in acceptance of patients' accounts. Conclusion These findings advance our understanding of how peoples' experiences of suicidality or self-harm are undermined or accepted in mental health encounters in the ED. They have important clinical implications: patients report that when their experiences are not accepted or undermined, this makes them more distressed, less hopeful about the future and discourages future help-seeking when in crisis. Conversely, acknowledging, accepting and validating suicidality/self-harm and introducing a new ways of understanding peoples' experiences may make people less suicidal and more hopeful, generates shared understanding and encourages future help-seeking.
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Affiliation(s)
- Clara Bergen
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Lisa Bortolotti
- Department of Philosophy, University of Birmingham, Birmingham, United Kingdom
| | | | | | - Carmen Lee
- Department of Psychology, University of Exeter, Exeter, United Kingdom
| | - Michele Lim
- Department of Psychology, University College London, London, United Kingdom
| | - Rose McCabe
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
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Uhl E, Raybin HB, Liu NH, Garza M, Barakat S, Muñoz RF, Leykin Y. Discrepancies in suicide screenings: Results from an international study. J Affect Disord 2023; 320:18-21. [PMID: 36179775 DOI: 10.1016/j.jad.2022.09.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/06/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND When screening for suicidality, clinicians usually ask questions in ascending order of severity. Clinicians often discontinue questioning after negative responses to the first question or questions, presuming that these individuals are unlikely to endorse any further suicidality. In this study, the accuracy of this presumption is evaluated in a large international sample. METHODS Participants were 21,385 individuals reporting a suicide attempt in the past two weeks. Participants were recruited, primarily via Google Ads, to a quintilingual (English, Spanish, Chinese, Arabic, and Russian) multinational depression and suicide screening study. RESULTS Examining three initial screening questions (i.e., thoughts of death, wanting to die, and thinking about committing suicide), 14.8 % (n = 3179) of participants denied one or more question, 3.96 % (n = 847) denied two, and 1.95 % (n = 416) denied all three questions. The proportions of individuals with discrepant responses differed between linguistic-geographical groups, with Chinese and South Asian groups being more likely to be discrepant across all questions (all ps < .001). LIMITATIONS Suicidality was assessed using an internet-based self-report measure, and linguistic-geographical groups explored in this study are very broad, which may limit generalizability. CONCLUSIONS Results suggest that prematurely discontinuing suicide screening may fail to capture some individuals who made a recent attempt, and that in some groups, this discrepancy may be more pronounced. Clinicians should assess all individuals as thoroughly as possible regardless of initial responses, inquire about other significant risk factors, and be culturally sensitive.
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Affiliation(s)
- Eric Uhl
- Palo Alto University, United States of America
| | | | - Nancy H Liu
- University of California, Berkeley, United States of America
| | - Monica Garza
- Legacy Community Health, United States of America
| | - Suzanne Barakat
- University of California, San Francisco, United States of America
| | - Ricardo F Muñoz
- Palo Alto University, United States of America; University of California, San Francisco, United States of America; Institute for International Internet Interventions for Health, United States of America
| | - Yan Leykin
- Palo Alto University, United States of America; University of California, San Francisco, United States of America; Institute for International Internet Interventions for Health, United States of America.
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Osborne D, De Boer K, Meyer D, Nedeljkovic M. Raising Suicide in Medical Appointments-Barriers and Facilitators Experienced by Young Adults and GPs: A Mixed-Methods Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:822. [PMID: 36613144 PMCID: PMC9820164 DOI: 10.3390/ijerph20010822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
The aim of this review was to understand the barriers and facilitators facing GPs and young adults in raising and addressing suicide in medical appointments. A mixed-methods systematic review was conducted of qualitative and quantitative studies. The focus was papers that explored barriers and facilitators experienced by young adults aged 18 to 26, and GPs working in primary care environments. Nine studies met the inclusion criteria. Four studies provided information on young adults' views, four on GPs, and one considered both GP and young adults' viewpoints. Nine barrier and seven facilitator themes were identified. Unique to this review was the recognition that young adults want GPs to initiate the conversation about suicide. They see this as a GP's responsibility. This review further confirmed that GPs lack the confidence and skills to assess suicide risk in young adults. Both findings combined could explain previous results for reduced identification of suicide risk in this cohort. GP training needs considerable focus on addressing skill deficiencies and improving GP confidence to assess suicide risk. However, introducing suicide risk screening in primary care for young adults should be a priority as this will overcome the need for young adults to voluntarily disclose thoughts of suicide.
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Nguyen W, Moles R, O'Reilly C, Robinson J, Brand-Eubanks D, Kim A, Collins JC, El-Den S. Observed behaviours and suicide assessment language post-Mental Health First Aid training in Australia and the United States: a mixed methods study using discourse analysis. BMC MEDICAL EDUCATION 2022; 22:838. [PMID: 36471288 PMCID: PMC9720991 DOI: 10.1186/s12909-022-03920-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Mental Health First Aid (MHFA) training teaches participants how to respond to mental health crises, including suicide. Little is known about the impact of training on participants' observed MHFA behaviours. This exploratory study aimed to compare MHFA-trained Australian and US student pharmacists' performance and suicide assessment language during simulated patient role-play (SPRP) assessments. METHODS Student pharmacists (n = 265) completed MHFA training and participated (n = 81) in SPRPs with simulated patients (SP) who were people with lived experience of mental illness. Each SPRP was marked by three raters (student, tutor and SP). One-way ANOVA, chi-squared tests and independent samples t-tests were used to compare scores and pass/fail rates, where appropriate. Transcribed audio-recordings of suicide assessments underwent discourse analysis. A chi-squared test was conducted to investigate the differences in how suicide assessment language was coded across six discursive frames ('confident'/'timid', 'empathetic'/'apathetic', and 'direct'/'indirect'). RESULTS Three raters assessed 81 SPRPs, resulting in quantitative analysis of 243 rubrics. There were no significant differences between student pharmacists' mean scores and pass/fail rates across countries. Overall, both cohorts across Australia and the US performed better during the mania scenario, with a low failure rate of 13.9 and 19.0%, respectively. Most students in both countries passed their SPRP assessment; however, 27.8% did not assess for suicide or used indirect language during suicide assessment, despite completing MHFA training. Australian student pharmacists demonstrated, more direct language (76.9% versus 67.9%) and empathy (42.3% versus 32.1%) but less confidence (57.7% versus 60.7%) compared to US student pharmacists, during their suicide assessment; however, these differences were not statistically significant. CONCLUSIONS Findings indicate most MHFA-trained student pharmacists from Australia and the US can provide MHFA during SPRPs, as well as assess for suicide directly, empathetically and confidently. This exploratory study demonstrates the importance of practicing skills post-training and the need for further research exploring participants' hesitance to assess for suicide, despite training completion.
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Affiliation(s)
- William Nguyen
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Rebekah Moles
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Claire O'Reilly
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Jennifer Robinson
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, USA
| | - Damianne Brand-Eubanks
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, USA
| | - Anne Kim
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, USA
| | - Jack C Collins
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Sarira El-Den
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
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Hawton K, Lascelles K, Pitman A, Gilbert S, Silverman M. Assessment of suicide risk in mental health practice: shifting from prediction to therapeutic assessment, formulation, and risk management. Lancet Psychiatry 2022; 9:922-928. [PMID: 35952701 DOI: 10.1016/s2215-0366(22)00232-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 12/20/2022]
Abstract
Suicide prevention in psychiatric practice has been dominated by efforts to predict risk of suicide in individual patients. However, traditional risk prediction measures have been shown repeatedly in studies from high income countries to be ineffective. Several factors might contribute to clinicians' preoccupation with risk prediction, which can have negative effects on patient care and also on clinicians where prediction is seen as failing. The model of therapeutic risk assessment, formulation, and management we outline in this article regards all patients with mental health problems as potentially at increased risk of suicide. It is aimed at reducing risk through use of a person-centred approach. We describe how a move towards therapeutic risk assessment, formulation, and risk management, including collaborative safety planning, could help clinicians develop a more tailored approach to managing risk for all patients, incorporating potentially therapeutic effects as well as helping to identify other risk reduction interventions. Such an approach could lead to enhanced patient safety and quality of care, which is more acceptable to patients.
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Affiliation(s)
- Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| | | | - Alexandra Pitman
- UCL Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | | | - Morton Silverman
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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9
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McCabe R. Communicating to connect with patients. BJPSYCH ADVANCES 2022. [DOI: 10.1192/bja.2022.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
Michaelson & Rahim describe a very welcome sustainable training framework for teaching clinical communication skills to trainees on MRCPsych courses. This commentary expands on their article, noting how psychiatrists listen and ask questions affects the therapeutic relationship and patients’ willingness or ability to disclose sensitive information, which is particularly important in risk assessment. Extending videorecording role-plays in training to routine (including remote) clinical consultations and involving patients and carers in training will be key to identifying communication that has a positive impact on patient experience and outcomes.
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Tietbohl CK, White AEC. Making Conversation Analysis Accessible: A Conceptual Guide for Health Services Researchers. QUALITATIVE HEALTH RESEARCH 2022; 32:1246-1258. [PMID: 35616449 DOI: 10.1177/10497323221090831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The quality of healthcare communication can impact both experiences and outcomes. We highlight aspects of communication that can be systematically examined using Conversation Analysis (CA) and provide guidance about how researchers can incorporate CA into healthcare studies. CA is a qualitative method for studying naturally occurring communication by analyzing recurrent, systematic practices of verbal and nonverbal behavior. CA involves examining audio- or video-recorded conversations and their transcriptions to identify practices speakers use to communicate and interpret behavior. We explain what distinguishes CA from other methods that study communication and highlight three accessible CA approaches that researchers can use in their research design, analysis, or implementation of communication interventions. Specifically, these approaches focus on how talk is produced (specific words, framing, and syntax), by whom, and when it occurs in the conversation. These approaches can be leveraged to generate hypotheses and to identify patterns of behavior that inform empirically driven communication interventions.
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Affiliation(s)
- Caroline K Tietbohl
- Adult and Child Center for Health Outcomes Research and Delivery Science, Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anne E C White
- Department of Family Medicine, Sanford Institute for Empathy and Compassion, University of California San Diego, La Jolla, CA, USA
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Sterie AC, Weber O, Jox RJ, Rubli Truchard E. "Do you want us to try to resuscitate?": Conversational practices generating patient decisions regarding cardiopulmonary resuscitation. PATIENT EDUCATION AND COUNSELING 2022; 105:887-894. [PMID: 34462247 DOI: 10.1016/j.pec.2021.07.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 07/18/2021] [Accepted: 07/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore how physicians elicit patients' preferences about cardio-pulmonary resuscitation (CPR) during hospital admission interviews. METHODS Conversation analysis of 37 audio-recorded CPR patient-physician discussions at admission to a geriatric hospital. RESULTS The most encountered practice is when physicians submit an option to the patient's validation ("do you want us to resuscitate"). Through it, physicians display presuppositions about the patient's preference, which is not elicited as an autonomous contribution. Through open elicitors ("what would you wish"), physicians treat patients as knowledgeable about options and autonomous in determining their preference. A third practice is related to patients delivering their preference in anticipation of the request and is encountered only for choices against CPR. These decisions are revealed as informed and autonomous, and the patient as collaborative. CONCLUSION The way that physicians elicit patients' preferences about CPR influences the delivery of autonomous and informed decisions. Our findings point to an asymmetry in ways of initiating talk about the possibility of not attempting CPR, potentially exacerbated by the context of admission interviews. PRACTICE IMPLICATIONS Decisions about the relevancy life-sustaining interventions need an adequate setting in order to allow for patient participation. Our findings have implications for communication training in regard to involving patients in conversations about goals of care.
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Affiliation(s)
- Anca-Cristina Sterie
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Switzerland; Palliative and Supportive Care Service and Service of Geriatric Medicine and Geriatric Rehabilitation, Chair of Geriatric Palliative Care, Lausanne University Hospital and University of Lausanne, Switzerland.
| | - Orest Weber
- Liaison Psychiatry Service, Lausanne University Hospital and University of Lausanne, Switzerland; Department of Language and Information Sciences, Faculty of Arts, University of Lausanne, Switzerland.
| | - Ralf J Jox
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Switzerland; Palliative and Supportive Care Service and Service of Geriatric Medicine and Geriatric Rehabilitation, Chair of Geriatric Palliative Care, Lausanne University Hospital and University of Lausanne, Switzerland; Institute of Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Switzerland.
| | - Eve Rubli Truchard
- Palliative and Supportive Care Service and Service of Geriatric Medicine and Geriatric Rehabilitation, Chair of Geriatric Palliative Care, Lausanne University Hospital and University of Lausanne, Switzerland; Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Switzerland.
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Polihronis C, Cloutier P, Kaur J, Skinner R, Cappelli M. What's the harm in asking? A systematic review and meta-analysis on the risks of asking about suicide-related behaviors and self-harm with quality appraisal. Arch Suicide Res 2022; 26:325-347. [PMID: 32715986 DOI: 10.1080/13811118.2020.1793857] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Research emphasizes the importance of asking about suicidality. Unfortunately, misperceptions of harm remain which can compromise clinical care, research, and public health surveillance efforts. Our objective was to evaluate the empirical evidence on whether and how asking about suicide related behaviors (SRB), such as suicidal ideation and suicide attempts, and non-suicidal self-injury (NSSI) results in harmful outcomes. We reviewed and rated seventeen studies and conducted a systematic review and random-effects meta-analysis on eight studies comparing those asked vs. not asked on immediate and later SRB, NSSI, and psychological distress (PD). Forest plots demonstrated no statistically significant effects of asking on SRB, NSSI, or PD. Eight RCTs provided the strongest evidence and demonstrated either low or unclear risk of bias, and the remaining cohort studies were of low to moderate quality. With the current available evidence, we found no harmful outcomes of asking, however more RCTs with a low risk of bias are required to firmly conclude that asking through self-report and interview methods does not further exacerbate distress, SRB and NSSI compared to those not asked.
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Alphs L, Fu DJ, Williamson D, Jamieson C, Greist J, Harrington M, Lindenmayer JP, McCullumsmith C, Sheehan DV, Shelton RC, Wicks P, Canuso CM. SIBAT-A Computerized Assessment Tool for Suicide Ideation and Behavior: Development and Psychometric Properties. INNOVATIONS IN CLINICAL NEUROSCIENCE 2022; 19:36-47. [PMID: 35958973 PMCID: PMC9341319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Most assessments of suicidal ideation and behavior (SIB) are limited by reliance on a single assessor, typically a clinician or patient, with scant detail on patient-related drivers of SIB and inability to detect rapid change in SIB. Furthermore, many techniques do not include a semistructured interview, increasing rater variability. The Suicide Ideation and Behavior Assessment Tool (SIBAT) addresses these limitations. DESIGN More than 30 experts in scale development, statistics, and clinical management of suicidal patients collaborated over a greater than four-year period to develop the SIBAT. Input for content and validity was received from patients, clinicians, and regulatory authorities in the United States (US) and Europe. Psychometric properties of the SIBAT were evaluated in validation studies. RESULTS The SIBAT is organized into eight independent patient- or clinician-rated modules with branching logic and scoring algorithms, which necessitates computerization. Patient-reported information is first captured in Modules 1 to 5. Thereafter, an experienced clinician reviews the patient's report, conducts a semistructured interview (Module 6), and assesses the patient's suicide risk (Module 7) and optimal antisuicide management (Module 8). Input from cognitive interviews of diverse adult, adolescent, and clinician participants was incorporated into the final version of the SIBAT. Psychometric testing demonstrated good inter-rater reliability (intraclass coefficient range: 0.68-0.82), intra-rater reliability (weighted-kappa range: 0.64-0.76), and concurrent validity with other instruments for assessing SIB. CONCLUSION Patient- and clinician-based assessments and the psychometric studies summarized in this report support the validity and reliability of the SIBAT for capturing critical information related to assessment of SIB in adolescents and adults at risk for suicide.
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Affiliation(s)
- Larry Alphs
- Dr. Alphs is with Denovo Biopharma in San Diego, California (he was with Janssen Scientific Affairs, LLC in Titusville, New Jersey at the time the work reported herein was performed)
| | - Dong-Jing Fu
- Drs. Fu and Canuso are with Janssen Research and Development, LLC in Titusville, New Jersey
| | - David Williamson
- Dr. Williamson is with the Departments of Psychiatry and Neurology at University of South Alabama College of Medicine in Mobile, Alabama and Department of Psychiatry and Health Behavior at Augusta University in Augusta, Georgia (he was with Janssen Scientific Affairs, LLC in Titusville, New Jersey at the time the work reported herein was performed)
| | - Carol Jamieson
- Ms. Jamieson is with Janssen Research and Development, LLC in Milpitas, California
| | - John Greist
- Dr. Greist is a Professor Emeritus–Psychiatry at the University of Wisconsin School of Medicine and Public Health and is with Healthcare Technology Systems, Inc. in Madison, Wisconsin
| | - Magdalena Harrington
- Dr. Harrington is with Pfizer, Inc. in Cambridge, Massachussetts (she was a Psychometrician/Patient-Reported Outcomes at PatientsLikeMe in Cambridge, Massachusetts at the time the work reported herein was performed)
| | - Jean-Pierre Lindenmayer
- Dr. Lindenmayer is with New York University Grossman School of Medicine, Department of Psychiatry in New York City, New York
| | - Cheryl McCullumsmith
- Dr. McCullumsmith is with the University of Toledo, Department of Psychiatry in Toledo, Ohio
| | - David V. Sheehan
- Dr. Sheehan is a Distinguished University Health Professor Emeritus, University of South Florida College of Medicine in Tampa, Florida
| | - Richard C. Shelton
- Dr. Shelton is with the University of Alabama at Birmingham School of Medicine, Department of Psychiatry in Birmingham, Alabama
| | - Paul Wicks
- Dr. Wicks is with Wicks Digital Health Ltd. in Lichfield, United Kingdom (he was with PatientsLikeMe in Cambridge, Massachusetts at the time the work reported herein was performed)
| | - Carla M. Canuso
- Drs. Fu and Canuso are with Janssen Research and Development, LLC in Titusville, New Jersey
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14
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Abstract
This is an article about exclusion. We might not like to admit it - even fail to realise it - but National Health Service (NHS) mental health service structures have become increasingly focused on how to deny people care instead of help them to access it. Clinicians learn the art of self-delusion, convincing ourselves we are not letting patients down but, instead, doing the clinically appropriate thing. Well-meant initiatives become misappropriated to justify neglect. Are we trying to protect ourselves against the knowledge that we're failing our patients, or is collusion simply the easiest option? Problematic language endemic in psychiatry reveals a deeper issue: a culture of fear and falsehood, leading to iatrogenic harm. An excessively risk-averse and under-resourced system may drain its clinicians of compassion, losing sight of the human being behind each 'protected' bed and rejected referral.
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Affiliation(s)
- Chloe Beale
- East London NHS Foundation Trust, London, UK.,Homerton University Hospital NHS Foundation Trust, London, UK
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15
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Terzioğlu C, Doğan S. The Effects of a Psychodrama-Based Risk Management Training Program on the Knowledge and Practices of Turkish Nurses in Psychiatric Clinics. Issues Ment Health Nurs 2022; 43:76-82. [PMID: 34232839 DOI: 10.1080/01612840.2021.1933279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study aimed to assess the effects of a psychodrama-based risk management training program on nurses' knowledge and practices. This study used a mixed methods design; quantitative and qualitative methods were used together with a single group pretest, post-test, and follow-up. The training program, in which the nurses took part, comprised six lessons that were designed using psychodrama methods. The result showed that risk management scores increased significantly after the training. Thus, this training is effective for improving the knowledge and practices of mental health nurses for risk management.
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Affiliation(s)
- Candan Terzioğlu
- Nursing Department, Faculty of Health Science, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Selma Doğan
- Nursing Department, Faculty of Health Science, Üsküdar University, Istanbul, Turkey
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16
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Scudder A, Rosin R, Baltich Nelson B, Boudreaux ED, Larkin C. Suicide Screening Tools for Pediatric Emergency Department Patients: A Systematic Review. Front Psychiatry 2022; 13:916731. [PMID: 35903632 PMCID: PMC9314735 DOI: 10.3389/fpsyt.2022.916731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND According to the Centers for Disease Control and Prevention, suicidality and suicidal behavior among youth continues to increase significantly each year. Many of those who die by suicide interact with health services in the year before death. This systematic review sought to identify and describe empirically tested screening tools for suicidality in youth presenting to Emergency Departments (ED). OBJECTIVE (1) To identify and compare existing tools used to screen for suicidality in children and adolescents who present to the ED and (2) to ascertain the prevalence of suicidality in pediatric populations found with these tools. METHODS We searched Ovid Medline, CINAHL, Scopus, and Cochrane databases for primary research studies that identified and evaluated screening tools for suicide risk in pediatric ED patients. A total of 7,597 publications published before August 25, 2021 met search criteria and were screened by two independent reviewers based on our inclusion and exclusion criteria, with any conflicts resolved via consensus meetings or an independent reviewer. A total of 110 papers were selected for full text review, of which 67 were excluded upon further inspection. Covidence was used to extract and synthesize results. RESULTS 43 articles were eligible for inclusion. Most studies (n = 33) took place in general pediatric EDs; the quality was generally high. Patients ranged from 4-24 years old, with most screening tested in patients 12 years and older. The most researched tools were the Ask-Suicide Screening Questions (ASQ) (n = 15), Columbia-Suicide Severity Rating Scale (C-SSRS) (n = 12), Suicidal Ideation Questionnaire (SIQ) (n = 11), and the Risk of Suicide Questionnaire (RSQ) (n = 7). Where screening was applied to all patients, about one-fifth of pediatric ED patients screened positive; where suicide screening was applied to psychiatric patients only, over half screened positive. Positive screens were more likely to be female and older than negative screens and they were more likely to be assessed and admitted. CONCLUSION Several validated screening tools exist for the purpose of screening pediatric populations in EDs for suicidality. Such tools may help to support early detection and appropriate intervention for youth at risk of suicide. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=276328, identifier: 276328.
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Affiliation(s)
| | - Richard Rosin
- New York Medical College, New York, NY, United States
| | | | - Edwin D Boudreaux
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Celine Larkin
- University of Massachusetts Chan Medical School, Worcester, MA, United States
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17
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Bellairs-Walsh I, Byrne SJ, Bendall S, Perry Y, Krysinska K, Lin A, Michail M, Lamblin M, Li TY, Hetrick S, Robinson J. Working with Young People at Risk of Suicidal Behaviour and Self-Harm: A Qualitative Study of Australian General Practitioners' Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12926. [PMID: 34948536 PMCID: PMC8701929 DOI: 10.3390/ijerph182412926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/25/2022]
Abstract
General Practitioners (GPs) play a crucial role in the identification and support of young people at risk of suicidal behaviour and self-harm; however, no studies have explored GPs' perspectives, approaches, challenges, and resource needs when working with this cohort in an Australian setting. This was a qualitative study where fifteen GPs (Mage = 45.25 years) from multiple clinics in Western Australia took part in semi-structured interviews, and data were analysed thematically. Seven main themes were identified: (1) working with young people has its unique challenges; (2) screening and assessment tools can help to manage uncertainty and discomfort; (3) going beyond tools-the dialogue and relationship are most important; (4) there are limits to what we can offer in the time available; (5) the service access and referral pathways lack clarity and coordination; (6) the provision of mental health support should not fall on GPs alone; and (7) more comprehensive training in suicide and self-harm is needed. The findings highlight a number of opportunities to enhance care and better assist GPs working with young people who present with suicidal behaviour and self-harm, including considerations for conducting assessments, targeted resources such as training, and system and service improvements.
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Affiliation(s)
- India Bellairs-Walsh
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Sadhbh J. Byrne
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Centre for Global Health, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Sarah Bendall
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Yael Perry
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, WA 6009, Australia; (Y.P.); (A.L.)
| | - Karolina Krysinska
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Centre for Mental Health, School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, WA 6009, Australia; (Y.P.); (A.L.)
| | - Maria Michail
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham B15 2TT, UK;
| | - Michelle Lamblin
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Tina Yutong Li
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Townsville University Hospital, Douglas, QLD 4814, Australia
| | - Sarah Hetrick
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1010, New Zealand
| | - Jo Robinson
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
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18
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Saul H, Gursul D. GPs may help people at risk of self-harm by asking open questions and acknowledging distress. BMJ 2021; 375:n2380. [PMID: 34697039 DOI: 10.1136/bmj.n2380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The studyFord J, Thomas F, Byng R, McCabe R. Asking about self-harm and suicide in primary care: moral and practical dimensions. Patient Educ Couns 2020;104:4.To read the full NIHR Alert go to: https://evidence.nihr.ac.uk/alert/open-questions-improve-gp-conversations-self-harm/.
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Affiliation(s)
- Helen Saul
- NIHR Central Commissioning Facility, Twickenham, UK
| | - Deniz Gursul
- NIHR Central Commissioning Facility, Twickenham, UK
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19
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Asking about suicide and self-harm: moving beyond clinician discomfort. Br J Gen Pract 2021; 71:217. [PMID: 33926873 DOI: 10.3399/bjgp21x715793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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20
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Ford J, Thomas F, Byng R, McCabe R. Asking about self-harm and suicide in primary care: Moral and practical dimensions. PATIENT EDUCATION AND COUNSELING 2021; 104:826-835. [PMID: 33162274 DOI: 10.1016/j.pec.2020.09.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 09/23/2020] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Self-harm and suicide are important topics to discuss with people experiencing mental health conditions. This study explores how such discussions unfold in practice, and how their moral and practical repercussions manifest for patients and doctors. METHODS Conversation analysis (CA) was used to examine 20 recorded examples of doctors' questions about self-harm and suicide and their ensuing discussions with patients. RESULTS A tendency to frame questions about self-harm towards a 'no' response, to amalgamate questions around self-harm and suicide, and to limit dialogue around the protective factors offered by family and friends restricted discussion of patients' experiences and concerns. Closed questions about thoughts and actions in the context of risk assessment resulted in missed opportunities to validate distressing thoughts. Patients responding affirmatively often did so in a way that distanced themselves from the negative stigma associated with suicide. CONCLUSION The wording of questions, along with negative stigma, can make it difficult for patients to talk about self-harm. PRACTICE IMPLICATIONS Discussions could be improved by asking about self-harm and suicide separately, encouraging discussion when responses are ambiguous and validating distressing thoughts. Negative stigma could be countered by exploring patients' positive reasons for wanting to stay alive.
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Affiliation(s)
- Joseph Ford
- College of Medicine and Health, University of Exeter, UK.
| | | | | | - Rose McCabe
- School of Health Sciences, City University of London, UK.
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21
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Addressing Concealed Suicidality: A Flexible and Contextual Approach to Suicide Risk Assessment in Adults. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2021. [DOI: 10.1007/s10879-021-09493-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Høyen KS, Solem S, Cohen LJ, Prestmo A, Hjemdal O, Vaaler AE, Galynker I, Torgersen T. Non-disclosure of suicidal ideation in psychiatric inpatients: Rates and correlates. DEATH STUDIES 2021; 46:1823-1831. [PMID: 33586630 DOI: 10.1080/07481187.2021.1879317] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The study explored how common non-disclosure of suicidal ideation is in a sample of adult psychiatric inpatients (N = 171) plus associated patient characteristics. A large percentage (51.5%) withheld some information on suicidal ideation during admission. In multivariable analyses, correlates of non-disclosure included a diagnosis of emotionally unstable personality disorder, low satisfaction with stay, and symptoms of the suicide crisis syndrome. In univariate analyses, therapists' emotional response to the patient was also a correlate. Findings indicate that among acute psychiatric inpatients, non-disclosure of suicidal ideation is quite common, requiring awareness from clinicians relying on this parameter in suicide risk assessments.
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Affiliation(s)
- Karina Sagmo Høyen
- Department of Østmarka, St. Olavs Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lisa Janet Cohen
- Carl Icahn School of Medicine, Mount Sinai/Mount Sinai Beth Israel, New York, New York, USA
| | - Astrid Prestmo
- Department of Østmarka, St. Olavs Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Einar Vaaler
- Department of Østmarka, St. Olavs Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Igor Galynker
- Carl Icahn School of Medicine, Mount Sinai/Mount Sinai Beth Israel, New York, New York, USA
| | - Terje Torgersen
- Department of Østmarka, St. Olavs Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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23
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Stevens K, Thambinathan V, Hollenberg E, Inglis F, Johnson A, Levinson A, Salman S, Cardinale L, Lo B, Shi J, Wiljer D, Korczak DJ, Cleverley K. Core components and strategies for suicide and risk management protocols in mental health research: a scoping review. BMC Psychiatry 2021; 21:13. [PMID: 33413192 PMCID: PMC7792084 DOI: 10.1186/s12888-020-03005-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/07/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Suicide and risk management protocols in mental health research aim to ensure patient safety, provide vital information on how to assess suicidal ideation, manage risk, and respond to unexpected and expected situations. However, there is a lack of literature that identifies specific components and strategies to include in suicide and risk management protocols (SRMPs) for mental health research. The goal of this scoping review was to review academic and grey literature to determine core components and associated strategies, which can be used to inform SRMPs in mental health research. METHODS AND ANALYSIS The methodological framework outlined by Arksey and O'Malley was used for this scoping review. The search strategy, conducted by a medical librarian, was multidisciplinary and included seven databases. Two reviewers independently assessed eligibility criteria in each document and used a standardized charting form to extract relevant data. The extracted data were then examined using qualitative content analysis. Specifically, summative content analysis was used to identify the core components and strategies used in SRMPs. The data synthesis process was iterative. RESULTS This review included 36 documents, specifically 22 peer-reviewed articles and 14 documents from the grey literature. Five core components of SRMPs emerged from the reviewed literature including: training; educational resources for research staff; educational resources for research participants; risk assessment and management strategies; and clinical and research oversight. Potentials strategies for risk mitigation within each of the core components are outlined. CONCLUSIONS The five core components and associated strategies for inclusion in SRMPs will assist mental health researchers in conducting research safely and rigorously. Findings can inform the development of SRMPs and how to tailor them across various research contexts.
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Affiliation(s)
- Katye Stevens
- The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Vivetha Thambinathan
- The Western Centre for Public Health and Family Medicine, Western University, London, Ontario, Canada
| | - Elisa Hollenberg
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Fiona Inglis
- Library Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Humber Libraries, Humber College, Toronto, Ontario, Canada
| | - Andrew Johnson
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andrea Levinson
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Soha Salman
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Leah Cardinale
- Lawrence S. Bloomberg Faculty of Nursing and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Brian Lo
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Information Management Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jenny Shi
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - David Wiljer
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Centre for Excellence in Economic Analysis Research, St. Michael's Hospital, Toronto, Ontario, Canada
- Education, Technology and Innovation, UHN Digital, University Health Network, Toronto, Ontario, Canada
| | - Daphne J Korczak
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kristin Cleverley
- The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Lawrence S. Bloomberg Faculty of Nursing and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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24
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Freedman S, Thull-Freedman J, Lightbody T, Prisnie K, Wright B, Coulombe A, Anderson LM, Stang AS, Mikrogianakis A, VanRiper L, Stubbs M, Newton A. Introducing an innovative model of acute paediatric mental health and addictions care to paediatric emergency departments: a protocol for a multicentre prospective cohort study. BMJ Open Qual 2020; 9:bmjoq-2020-001106. [PMID: 33318032 PMCID: PMC7737085 DOI: 10.1136/bmjoq-2020-001106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/16/2020] [Accepted: 11/28/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Children and youth with mental health and addiction crises are a vulnerable patient group that often are brought to the hospital for emergency department care. We propose to evaluate the effect of a novel, acute care bundle that standardises a patient-centred approach to care. METHODS AND ANALYSIS Two paediatric emergency departments in Alberta, Canada are involved in this prospective, pragmatic, 29-month interventional quasi-experimental study. The acute care bundle comprises three components, applied when appropriate: (1) assessing self-harm risk at triage using the Ask Suicide-Screening Questionnaire (ASQ) to standardise the questions administered, enabling risk stratification; (2) use of the HEADS-ED (Home, Education, Activities/peers, Drug/alcohol, Suicidality, Emotions and behaviour, Discharge Resources) to focus mental health evaluations for those who screen high risk on the ASQ; and (3) implementation of a Choice And Partnership Approach to enable shared decision making in care following the emergency department visit. The overarching goal is to deliver the right care at the right place and time for the patients. The study design involves a longitudinal collection of data 12 months before and after the introduction of the bundle and the use of quality improvement strategies such as Plan-Do-Study-Act cycles during a 5-month run-in period to test and implement changes. The primary study end-point is child/youth well-being 1 month after the emergency department visit. Secondary outcomes include family functioning, child/youth well-being at 3 and 6 months, satisfaction with emergency department care, and health system outcomes (hospital admissions, length of emergency department stays, emergency department revisits). ETHICS AND DISSEMINATION The study is registered at www.ClinicalTrials.gov and has received ethics and operational approvals from study sites. The results of the study will be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. Results will be shared broadly with key policy and decision makers and disseminated in peer-reviewed academic journals and presentations at conferences. TRIAL REGISTRATION NUMBER NCT04292379.
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Affiliation(s)
- Stephen Freedman
- Department of Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Jennifer Thull-Freedman
- Department of Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Teresa Lightbody
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Children, Youth, and Families, Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Kassi Prisnie
- Department of Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Bruce Wright
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Emergency Department, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Angela Coulombe
- Children, Youth, and Families, Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Linda M Anderson
- Emergency Department, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Antonia S Stang
- Department of Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Angelo Mikrogianakis
- Emergency Department, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Department of Pediatrics, Faculty of Health Sciences, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lindy VanRiper
- Emergency Department, Stollery Children's Hospital, Edmonton, Alberta, Canada.,Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Stubbs
- Department of Psychiatry, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Amanda Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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25
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Stallman HM. Online needs‐based and strengths‐focused suicide prevention training: Evaluation of Care · Collaborate · Connect. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Helen M. Stallman
- School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, South Australia, Australia,
- Basil Hetzel Institute, The Queen Elizabeth Hospital Woodville South, South Australia, Australia,
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26
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Jayasinghe L, Bittar A, Dutta R, Stewart R. Clinician-recalled quoted speech in electronic health records and risk of suicide attempt: a case-crossover study. BMJ Open 2020; 10:e036186. [PMID: 32327481 PMCID: PMC7204853 DOI: 10.1136/bmjopen-2019-036186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/18/2020] [Accepted: 03/25/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Clinician narrative style in electronic health records (EHR) has rarely been investigated. Clinicians sometimes record brief quotations from patients, possibly more frequently when higher risk is perceived. We investigated whether the frequency of quoted phrases in an EHR was higher in time periods closer to a suicide attempt. DESIGN A case-crossover study was conducted in a large mental health records database. A natural language processing tool was developed using regular expression matching to identify text occurring within quotation marks in the EHR. SETTING Electronic records from a large mental healthcare provider serving a geographic catchment of 1.3 million residents in South London were linked with hospitalisation data. PARTICIPANTS 1503 individuals were identified as having a hospitalised suicide attempt from 1 April 2006 to 31 March 2017 with at least one document in both the case period (1-30 days prior to admission) and the control period (61-90 days prior to admission). OUTCOME MEASURES The number of quoted phrases in the control as compared with the case period. RESULTS Both attended (OR 1.05, 95% CI 1.02 to 1.08) and non-attended (OR 1.15, 95% CI 1.04 to 1.26) clinical appointments were independently higher in the case compared with control period, while there was no difference in mental healthcare hospitalisation (OR 0.99, 95% CI 0.98 to 1.01). In addition, there was no difference in the levels of quoted text between the comparison time periods (OR 1.09, 95% CI 0.91 to 1.30). CONCLUSIONS This study successfully developed an algorithm to identify quoted speech in text fields from routine mental healthcare records. Contrary to the hypothesis, no association between this exposure and proximity to a suicide attempt was found; however, further evaluation is warranted on the way in which clinician-perceived risk might be feasibly characterised from clinical text.
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Affiliation(s)
- Lasantha Jayasinghe
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - André Bittar
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rina Dutta
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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27
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O'Connor L, Larkin C, Ibrahim AF, Allen M, Wang B, Boudreaux ED. Development and pilot study of simple suicide risk rulers for use in the emergency department. Gen Hosp Psychiatry 2020; 63:97-102. [PMID: 30121140 DOI: 10.1016/j.genhosppsych.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 08/03/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Many patients treated in the emergency department (ED) for non-psychiatric complaints have elevated suicide risk. Universal screening can detect occult suicide risk, but gold standard risk measurement tools, such as the Beck Scale for Suicidal Ideation (BSS), are too long and cumbersome for ED use. OBJECTIVE To test the performance of seven novel 0- to 10-point suicide risk "rulers" against the BSS. METHOD 399 patients from three EDs completed seven novel risk rulers, traditional binary screening items, and the BSS. Using BSS criterion references, we tested the diagnostic performance of each risk ruler and examined correlations between the rulers and BSS scores. RESULTS By varying thresholds on the risk rulers, high levels of sensitivity and specificity were obtained. A threshold of 3 on the "sadness" ruler gave 89% sensitivity for the BSS criterion reference, and a threshold of 1 on the "wish to be dead" ruler provided 94-97% specificity. CONCLUSION Our novel risk rulers may be an efficient way to detect risk and triage potentially suicidal patients, showing good concurrent validity with the BSS. Clinicians can obtain high sensitivity and high specificity using just two rulers. Further research should examine the rulers' ability to predict independent clinician risk ratings and prospective suicidal behavior.
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Affiliation(s)
- Laurel O'Connor
- Department of Emergency Medicine, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States of America. laurel.o'
| | - Celine Larkin
- Department of Emergency Medicine, University of Massachusetts, 55 Lake Avenue North, Worcester, MA 01655, United States of America
| | - Ameer F Ibrahim
- Department of Emergency Medicine, University of Massachusetts, 55 Lake Avenue North, Worcester, MA 01655, United States of America
| | - Michael Allen
- Department of Psychiatry, University of Colorado at Denver, 500 - 13001 E. 17th Place, Bldg. 500, Level 2, Rm. E2308, Aurora, CO 80045, United States of America
| | - Bo Wang
- Department of Emergency Medicine, University of Massachusetts, 55 Lake Avenue North, Worcester, MA 01655, United States of America
| | - Edwin D Boudreaux
- Department of Emergency Medicine, University of Massachusetts, 55 Lake Avenue North, Worcester, MA 01655, United States of America
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Barzilay S, Schuck A, Bloch-Elkouby S, Yaseen ZS, Hawes M, Rosenfield P, Foster A, Galynker I. Associations between clinicians' emotional responses, therapeutic alliance, and patient suicidal ideation. Depress Anxiety 2020; 37:214-223. [PMID: 31730737 DOI: 10.1002/da.22973] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 09/15/2019] [Accepted: 10/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health clinicians frequently experience intense negative emotional responses to suicidal patients, which have been related to treatment outcome. This study examines the therapeutic alliance as a mediator of the relationship between clinicians' negative emotional responses at the initial encounter and patients' suicidal ideation (SI) concurrently and 1 month later. METHODS We assessed 378 adult psychiatric outpatients (62.7% female; mean age = 39.1 ± 14.6 years) and their 61 treating clinicians. Following the initial encounter, self-report questionnaires assessed clinicians' emotional responses to their patients, patients' and clinicians' perception of the therapeutic alliance, and patients' SI. The SI was reassessed 1 month after the initial visit. Multilevel mediation analyses were performed. RESULTS Patients' (but not clinicians') perception of the therapeutic alliance mediated the relationship between clinicians' negative emotional responses to patients and patients' SI 1 month following the initial visit (indirect effect estimate = 0.015; p < .001). CONCLUSIONS The association between clinicians' negative emotional response and patients' prospective SI appears to be transmitted, at least partly, through the patients' perception of the poorer early quality of the therapeutic alliance. Thus, clinicians' awareness and management of their emotional states appear essential both for the identification of suicidal risk and to enhance therapeutic alliance and treatment outcomes.
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Affiliation(s)
- Shira Barzilay
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Allison Schuck
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York, New York
| | - Sarah Bloch-Elkouby
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York, New York
| | - Zimri S Yaseen
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York, New York
| | - Mariah Hawes
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York, New York
| | - Paul Rosenfield
- Department of Psychiatry, Mount Sinai St. Luke's, New York, New York
| | - Adriana Foster
- Department of Psychiatry and Behavioral Health, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Igor Galynker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York, New York
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29
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Fehling KB, Selby EA. Suicide in DSM-5: Current Evidence for the Proposed Suicide Behavior Disorder and Other Possible Improvements. Front Psychiatry 2020; 11:499980. [PMID: 33613330 PMCID: PMC7891495 DOI: 10.3389/fpsyt.2020.499980] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
Suicide continues to be one of the greatest challenges faced by mental health clinicians and researchers, an issue made worse by increasing trends in the global suicide rate. Suicide behavior disorder (SBD) was introduced in DSM-5 as a disorder for further consideration and potential acceptance into the diagnostic system. There are numerous positive developments that would arise from the addition of a suicide-related diagnosis. Utilizing the 2009 guidelines established by Kendler and colleagues, the present review examines the evidence for SBD's validity and discusses the diagnosis' potential clinical benefits and limitations. Altogether, growing evidence indicates that SBD has preliminary validity and benefit. SBD presents with several significant limitations, however, and possible alternative additions to future DSMs are highlighted.
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Affiliation(s)
| | - Edward A Selby
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
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30
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Savander EÈ, Weiste E, Hintikka J, Leiman M, Valkeapää T, Heinonen EO, Peräkylä A. Offering patients opportunities to reveal their subjective experiences in psychiatric assessment interviews. PATIENT EDUCATION AND COUNSELING 2019; 102:1296-1303. [PMID: 30833136 DOI: 10.1016/j.pec.2019.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 01/24/2019] [Accepted: 02/19/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE With the intention of understanding the dynamics of psychiatric interviews, we investigated the usual (DSM/ICD-based) psychiatric assessment process and an alternative assessment process based on a case formulation method. We compared the two different approaches in terms of the clinicians' practices for offering patients opportunities to reveal their subjective experiences. METHODS Using qualitative and quantitative applications of conversation analysis, we compared patient-clinician interaction in five usual psychiatric assessments (AAU) with five assessment interviews based on dialogical sequence analysis (DSA). RESULTS The frequency of conversational sequences where the patient described his/her problematic experiences was higher in the DSA interviews than in the AAU interviews. In DSA, the clinicians typically facilitated the patient's subjective experience talk by experience-focused questions and formulations, whereas in AAU, such talk typically occurred in environments where the clinicians' questions and formulations focused on non-experiential, medical matters. CONCLUSION Interaction in DSA was organized to provide for the patient's experience-focused talk, whereas in AAU, the patient needed to go against the conversational grain to produce such talk. PRACTICE IMPLICATIONS By facilitating patients' opportunities to uncover subjective experiences, it is possible to promote their individualized care planning in psychiatry.
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Affiliation(s)
| | - Elina Weiste
- University of Helsinki, Department of Social Sciences, Helsinki, Finland.
| | - Jukka Hintikka
- Päijät-Häme Central Hospital, Department of Psychiatry, Lahti, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | | | - Taina Valkeapää
- University of Helsinki, Department of Social Sciences, Helsinki, Finland.
| | - Erkki O Heinonen
- York University, Department of Psychology, Toronto, Canada; University of Helsinki, Department of Psychology and Logopedics, Helsinki, Finland.
| | - Anssi Peräkylä
- University of Helsinki, Department of Social Sciences, Helsinki, Finland.
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31
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Blanchard M, Farber BA. "It is never okay to talk about suicide": Patients' reasons for concealing suicidal ideation in psychotherapy. Psychother Res 2018; 30:124-136. [PMID: 30409079 DOI: 10.1080/10503307.2018.1543977] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: To identify psychotherapy clients' motives for concealing suicidal ideation from their therapist, and their perceptions of how their therapists could better elicit honest disclosure. Method: A sample of 66 psychotherapy clients who reported concealing suicidal ideation from their therapist provided short essay responses explaining their motives for doing so and what their therapist could do to help them be more honest. Content analysis was used to identify major motives and themes in these responses. Results: Seventy percent of suicidal ideation concealers cited fear of unwanted practical impacts outside therapy as the reason they did not disclose. Chief among these unwanted impacts was involuntary hospitalization, a perceived outcome of disclosing even mild suicidal thoughts. Less concrete motives for concealment, such as shame or embarrassment, were significant but secondary concerns. Nearly half of suicide-concealing clients said they would be more honest only if the threat of hospitalization was somehow reduced or controlled. Conclusion: Fostering disclosure of suicidal ideation in therapy may require renewed attention to providing transparent, comprehensive, and easy-to-understand psychoeducation about the triggers for hospitalization and other interventions. Clients make risk-benefit calculations about whether to disclose suicidal ideation, but may operate with exaggerated or inaccurate ideas about the consequences of disclosure.
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Affiliation(s)
- Matt Blanchard
- Teachers College, Columbia University, New York, NY, USA
| | - Barry A Farber
- Teachers College, Columbia University, New York, NY, USA
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32
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Abstract
Researchers are increasingly interested in how clinicians should screen for suicide ideation in care settings and the merits of doing so. A common finding is that screening does no harm, and may do good, insofar as once the subject of suicide is broached clinicians can conduct a suicide risk assessment to determine the course of safe care. To date, little has been published about just how clinicians should ask "the ask" about suicidal ideation. The aim of this article is to suggest that the difficulty clinicians seem to have in initiating a verbal probe for suicidal ideation has less to do with patient characteristics than it does with clinician anticipatory anxiety about learning that a patient is positive for suicidal ideation. Face-negotiation theory and politeness theory are offered as possible explanations for why a simple direct question is so difficult to ask. Future research directions are suggested and an absence of data from public health gatekeeper training is offered as argument for clinicians to be more direct in their probes for suicidal ideation.
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Affiliation(s)
- Paul Quinnett
- QPR Institute, Spokane, WA, USA.,University of Washington School of Medicine, Department of Psychiatry and Behavioral Health, Seattle, WA, USA
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33
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Muñoz-Sánchez JL, Sánchez-Gómez MC, Martín-Cilleros MV, Parra-Vidales E, de Leo D, Franco-Martín MA. Addressing Suicide Risk According to Different Healthcare Professionals in Spain: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102117. [PMID: 30261622 PMCID: PMC6210587 DOI: 10.3390/ijerph15102117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/21/2018] [Accepted: 09/23/2018] [Indexed: 12/25/2022]
Abstract
This study analyzes the views of four groups of healthcare professionals who may play a role in the management of suicidal behavior. The goal was to identify key factors for suicide prevention in different areas of the healthcare system. Qualitative research was conducted using focus groups made up of different healthcare professionals who participated in the identification, management, and prevention of suicidal behavior. Professionals included were primary care physicians, psychologists, psychiatrists, and emergency physicians. 'Suicide' was amongst the most relevant terms that came up in discussions most of the times it appeared associated with words such as 'risk', danger', or 'harm'. In the analysis by categories, the four groups of professionals agreed that interventions in at-risk behaviors are first in importance. Prevention was the second main concern with greater significance among psychiatrists. Primary care professionals call for more time to address patients at risk for suicide and easier access to and communication with the mental health network. Emergency care professionals have a lack of awareness of their role in the detection of risk for suicide in patients who seek attention at emergency care facilities for reasons of general somatic issues. Mental health care professionals are in high demand in cases of self-harm, but they would like to receive specific training in dealing with suicidal behavior.
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Affiliation(s)
- Juan-Luis Muñoz-Sánchez
- Psychiatry and Mental Health Department, Hospital Universitario Río Hortega, C/ Dulzaina, 2, 47012 Valladolid, Spain.
| | - María Cruz Sánchez-Gómez
- Departamento de Didáctica, Organización y Métodos de Investigación, Facultad de Educación, Universidad de Salamanca, Paseo de Canalejas 169, 37008 Salamanca, Spain.
| | - María Victoria Martín-Cilleros
- Departamento de Didáctica, Organización y Métodos de Investigación, Facultad de Educación, Universidad de Salamanca, Paseo de Canalejas 169, 37008 Salamanca, Spain.
| | | | - Diego de Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Mt Gravatt Campus, Mount Gravatt, QLD 4122, Australia.
| | - Manuel A Franco-Martín
- Psychiatry and Mental Health Department, Hospital Universitario Río Hortega, C/ Dulzaina, 2, 47012 Valladolid, Spain.
- Departamento de Personalidad, Evaluación y Tratamiento psicológico, Facultad de Psicología, Universidad de Salamanca, Campus Ciudad Jardín, 37005 Salamanca, Spain.
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34
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Blades CA, Stritzke WGK, Page AC, Brown JD. The benefits and risks of asking research participants about suicide: A meta-analysis of the impact of exposure to suicide-related content. Clin Psychol Rev 2018; 64:1-12. [PMID: 30014862 DOI: 10.1016/j.cpr.2018.07.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/29/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Abstract
One obstacle potentially hindering research on suicide is the assumption that assessing suicide may make individuals more likely to engage in suicidal thoughts or behaviours; a concern expressed by ethics committees, researchers, and clinicians. However, decisions which are overly cautious and restrictive when approving research proposals will hinder important research in this area. The present aim was to conduct a meta-analysis to examine whether asking about suicide or exposure to suicide-related content in research studies led to changes in participants' levels of distress, suicidal ideation, or suicide attempts. A systematic search of peer-reviewed and unpublished literature from 2000 to 2017 identified 18 studies. Exposure to suicide-related content led to significant, albeit small, reductions in suicidal ideation (g = -0.13, p < .001) and a lower likelihood of engaging in suicidal behaviour (OR = 0.714, p < .05). The reduction in suicidal ideation was moderated by age such that adolescents showed nearly twice as large a reduction in suicidal ideation from pre- to post-exposure as adults did. Thus, evidence to date suggests that asking research participants about suicide does not increase risk, and may be associated with small benefits. Ethics review boards should calibrate their consideration of the risks associated with participation based on the available evidence and relative to the cost of depriving potential participants of any benefits that participation may offer.
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Affiliation(s)
- Caroline A Blades
- School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia.
| | - Werner G K Stritzke
- School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia.
| | - Andrew C Page
- School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia.
| | - Julia D Brown
- School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia.
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35
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Flintoff A, Speed E, McPherson S. Risk assessment practice within primary mental health care: A logics perspective. Health (London) 2018; 23:656-674. [PMID: 29652182 DOI: 10.1177/1363459318769471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
From the 1980s onwards, discourses of risk have continued to grow, almost in ubiquity. Ideas and practices of risk and risk aversion have extended to UK mental health care where services are expected to assess and manage risks, and high-quality clinical assessment has been revised to incorporate risk assessment. This article problematises practices of risk assessment in mental health provision, focussing on the base-rate problem. It presents an analysis of audio recordings of risk assessments completed within a primary care mental health service. The analysis is informed by a critical logics approach which, using ideas from discourse theory as well as Lacanian psychoanalysis, involves developing a set of logics to describe, analyse and explain social phenomena. We characterise the assessments as functioning according to social logics of well-oiled administration and preservation, whereby bureaucratic processes are prioritised, contingency ironed out or ignored, and a need to manage potential risks to the service are the dominant operational frames. These logics are considered in terms of their beatific and horrific fantasmatic dimensions, whereby risk assessment is enacted as infallible (beatific) until clients become threats (horrific), creating a range of potential false negatives, false positives and so forth. These processes function to obscure or background problems with risk assessment, by generating practices that favour and offer protection to assessors, at the expense of those being assessed, thus presenting a challenge to the stated aim of risk assessment practice.
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36
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Berman AL, Silverman MM. How to Ask About Suicide? A Question in Need of an Empirical Answer. CRISIS 2017; 38:213-216. [DOI: 10.1027/0227-5910/a000501] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Alan L. Berman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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