How do healthcare professionals interview patients to assess suicide risk?

BMC Psychiatry

Research Article

Imren Sterno¹  Richard Byng²  Stefan Priebe³  Rebecca Barnes⁴  Rose McCabe⁵ 

[1] Live Well Suffolk, 8 Turret Lane, IP4 1DL, Ipswich, UK;Plymouth University Peninsula Schools of Medicine and Dentistry, N32, Tamar Science Park, Drake Circus, PL4 8AA, Plymouth, Devon, UK;Unit for Social and Community Psychiatry, Queen Mary University of London, Newham Centre for Mental Health, E13 8SP, London, UK;University of Bristol, Office Room 1.05 Canynge Hall, 39 Whatley Road, BS8 2PS, Bristol, UK;University of Exeter Medical School, Room 1.05, College House, EX1 2 LU, Exeter, UK;

关键词: Suicide;    Risk;    Communication;    Assessment;    Conversation analysis;    Mixed methods;    Mental health care;   

DOI  :  10.1186/s12888-017-1212-7

 received in 2016-10-01, accepted in 2017-01-19,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThere is little evidence on how professionals communicate to assess suicide risk. This study analysed how professionals interview patients about suicidal ideation in clinical practice.MethodsThree hundred nineteen video-recorded outpatient visits in U.K. secondary mental health care were screened. 83 exchanges about suicidal ideation were identified in 77 visits. A convenience sample of 6 cases in 46 primary care visits was also analysed. Depressive symptoms were assessed. Questions and responses were qualitatively analysed using conversation analysis. χ2 tested whether questions were influenced by severity of depression or influenced patients’ responses.ResultsA gateway closed question was always asked inviting a yes/no response. 75% of questions were negatively phrased, communicating an expectation of no suicidal ideation, e.g., “No thoughts of harming yourself?”. 25% were positively phrased, communicating an expectation of suicidal ideation, e.g., “Do you feel life is not worth living?”. Comparing these two question types, patients were significantly more likely to say they were not suicidal when the question was negatively phrased but were not more likely to say they were suicidal when positively phrased (χ2 = 7.2, df = 1, p = 0.016). 25% patients responded with a narrative rather than a yes/no, conveying ambivalence. Here, psychiatrists tended to pursue a yes/no response. When the patient responded no to the gateway question, the psychiatrist moved on to the next topic. A similar pattern was identified in primary care.ConclusionsPsychiatrists tend to ask patients to confirm they are not suicidal using negative questions. Negatively phrased questions bias patients’ responses towards reporting no suicidal ideation.

【 授权许可】

CC BY   
© The Author(s). 2017