How do healthcare professionals interview patients to assess suicide risk?
© The Author(s). 2017 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
BACKGROUND: There is little evidence on how professionals communicate to assess suicide risk. This study analysed how professionals interview patients about suicidal ideation in clinical practice. METHODS: Three 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. χ2tested whether questions were influenced by severity of depression or influenced patients' responses. RESULTS: A 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. CONCLUSIONS: Psychiatrists tend to ask patients to confirm they are not suicidal using negative questions. Negatively phrased questions bias patients' responses towards reporting no suicidal ideation.
The research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust (McCabe, Byng); East London NHS Foundation Trust (McCabe, Sterno, Priebe); ESRC/MRC Interdisciplinary Studentship PTA-037-2006-00014 (Storey); NHS R&D Researcher Development Award (Byng). The funders had no role in design or conduct of the study, collection, analysis, interpretation and management of data, preparation and review of the manuscript, or decision to submit for publication. All study researchers were independent from the funders.
This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.
Vol. 17: 122
Place of publication