The online version of this article (doi:10.1186/s12888-017-1212-7) contains supplementary material, which is available to authorized users.
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.
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. χ 2 tested whether questions were influenced by severity of depression or influenced patients’ responses.
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 (χ 2 = 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.
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.
Additional file 1: Transcription conventions. Transcription Conventions. Explanation of transcription symbols used in analysing the communication data. (DOCX 42 kb)12888_2017_1212_MOESM1_ESM.docx
World Health Organisation. Public Health Action for the Prevention of Suicide: A Framework. 2012. http://apps.who.int/iris/bitstream/10665/75166/1/9789241503570_eng.pdf?ua=1. Accessed 14 April 2014.
Appleby L, Shaw J, Meehan J, et al. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (Great Britain). Safety First: Five-year Report of the National Confidential Inquiry Into Homicide by People with Mental Illness: Summary. Department of Health, 2001.
Saini P, Windfuhr K, Pearson A, Da Cruz D, Miles C, Cordingley L, While D, Swinson N, Williams A, Shaw J, Appleby L. Suicide prevention in primary care: General practitioners' views on service availability. BMC Res Notes. 2010;3(1):1. CrossRef
Shea SC. Suicide assessment: part 1: uncovering suicidal intent--a sophisticated art. Psychiatric Times. 2009;26(12):17.
Cole-King A, Parker V, Williams H, Platt S. Suicide prevention: are we doing enough? Adv Psychiatr Treat. 2013;19(4):284–91. CrossRef
Cole-King A, Green G, Gask L, Hines K, Platt S. Suicide mitigation: a compassionate approach to suicide prevention. Adv Psychiatr Treat. 2013;19(4):276–83. CrossRef
Clark DC, Fawcett J. Review of empirical risk factors for evaluation of the suicidal patient. In: Bongar BM, editor. Suicide: Guidelines for assessment, management, and treatment. New York: Oxford University Press; 1992. p. 16–48.
Fremouw WJ, De Perczel M, Ellis TE. Suicide Risk: Assessment and Response Guidelines. Pergamon Press: University of Virginia; 1999.
Hawton K, Casañas i Comabella C, Saunders K, Haw C. Assessment of suicide risk in people with depression. http://cebmh.warne.ox.ac.uk/csr/clinicalguide/docs/Assessment-of-suicide-risk--clinical-guide.pdf. Accessed 20 Sept 2016.
Shea SC. The chronological assessment of suicide events: a practical interviewing strategy for the elicitation of suicidal ideation. J Clin Psychiatry. 1998;59 Suppl 20:58–72. PubMed
Raymond G. Grammar and social organization: Yes/no interrogatives and the structure of responding. Am Sociol Rev. 2003:939-67
Morgan G, Buckley C, Nowers M. Face to face with the suicidal. Adv Psychiatr Treat. 1998;4(4):188–96. CrossRef
Fiedorowicz JG, Weldon K, Bergus G. Determining suicide risk (hint: a screen is not enough): it takes more than an algorithm to accurately assess suicide risk. These tips will help you individualize your approach. J Fam Pract. 2010;59(5):256–61. PubMed
Boyd E, Heritage J. Taking the patient's medical history: Questioning during comprehensive history taking. In: Heritage J, Maynard D, editors. Communication in medical care: Interactions between primary care physicians and patients. Cambridge: Cambridge University Press; 2006. p. 151–84. CrossRef
Pomerantz A. Agreeing and disagreeing with assessments: some features of preferred/dispreferred turn shapes. In: Atkinson JM, Heritage J, editors. Structures of social action. Cambridge: Cambridge University Press; 1984. p. 57–101.
Heritage J. Questioning in Medicine. In: Freed A, Ehrlich S, editors. “Why Do You Ask?": The Function of Questions in Institutional Discourse. New York: Oxford University Press; 2010. p. 42–68.
Horn L. A natural history of negation. Chicago: University of Chicago Press; 1989.
Karasz A, Dowrick C, Byng R, Buszewicz M, Ferri L, Hartman TC, Van Dulmen S, van Weel-Baumgarten E, Reeve J. What we talk about when we talk about depression: doctor-patient conversations and treatment decision outcomes. Br J Gen Pract. 2012;62(594):55–63. CrossRef
Sacks H, Schegloff EA, Jefferson G. A simplest systematics for the organization of turn-taking for conversation. Language. 1974;696-735
Raymond G. Questions at work: Yes/no type interrogatives in institutional contexts. In: Drew P, Raymond G, Weinberg D, editors. Talk and Interaction in Social Research Methods. London: Sage; 2006. p. 115–34.
Beach WA. Conversation analysis:“Okay” as a clue for understanding consequentiality. The consequentiality of communication. 1995:121-61.
Stivers T, Hayashi M. Transformative answers: One way to resist a question’s constraints. Lang Soc. 2010;39(01):1–25. CrossRef
Gao K, Wu R, Wang Z, Ren M, Kemp DE, Chan PK, Conroy CM, Serrano MB, Ganocy SJ, Calabrese JR. Disagreement between self-reported and clinician-ascertained suicidal ideation and its correlation with depression and anxiety severity in patients with major depressive disorder or bipolar disorder. J Psychiatr Res. 2015;60:117–24. CrossRefPubMed
Rahman MS, Gupta S, While D, Rodway C, Ibrahim S, Bickley H, Flynn S, Windfuhr K, Shaw J, Kapur N, Appleby L. Quality of risk assessment prior to suicide and homicide: A pilot study. 2013. http://www.bbmh.manchester.ac.uk/cmhr/research/centreforsuicideprevention/nci/reports/RiskAssessmentfullreport2013.pdf. Accessed 14 April 2014.
Haynal-Reymond V, Jonsson GK, Magnusson MS. Non-Verbal Communication in Doctor-Suicidal Patient Interview. In: Anolli L, Duncan Jr S, Magnusson MS, Riva G, editors. The Hidden Structure of Interaction: From Neurons to Culture Patterns. Amsterdam: IOS Press; 2005. p. 142–8.
Heritage J, Clayman S. Talk in Action: Interactions, Identities, and Institutions. West Sussex: Wiley-Blackwell; 2010. CrossRef
Office of the Surgeon General (US); National Action Alliance for Suicide Prevention (US). National Strategy for Suicide Prevention: Goals and Objectives for Action: A Report of the U.S. Surgeon General and of the National Action Alliance for Suicide Prevention. Washington (DC): US Department of Health & Human Services (US). 2012. http://www.surgeongeneral.gov/library/reports/national-strategy-suicide-prevention/full_report-rev.pdf. Accessed 02 April 2015.
Department of Health. Preventing Suicide in England - A Cross-Government Outcomes Strategy to Save Lives. 2012. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216928/Preventing-Suicide-in-England-A-cross-government-outcomes-strategy-to-save-lives.pdf. Accessed 16 April 2014
- How do healthcare professionals interview patients to assess suicide risk?
- BioMed Central
Neu im Fachgebiet Psychiatrie
Meistgelesene Bücher aus dem Fachgebiet
Mail Icon II