Barriers and facilitators of suicide risk assessment in emergency departments: a qualitative study of provider perspectives

Petrik, Megan L.; Gutierrez, Peter M.; Berlin, Jon S.; Saunders, Stephen M.

doi:10.1016/j.genhosppsych.2015.06.018

Cited by 83 publications

(68 citation statements)

References 32 publications

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“…[26] In our study, patients seen only by an ED physician, without an evaluation by a mental health consultant, were less likely to have documented lethal means assessment. This may relate to differences in training or awareness about lethal means counseling among ED and mental health providers, but it may also stem from overall perceived level of risk.…”

Section: Discussionmentioning

confidence: 87%

“…The suboptimal rates of lethal means assessment may stem from issues related to providers (e.g., inadequate training or unclear delineation of responsibilities) [13,14,[23][24][25] and the ED environment (e.g., busy and crowded). [26] In our study, patients seen Dotted areas represent patient populations of higher concern (discharged home; without documented assessment of access to lethal means; and with ࣙ1 firearm at home).…”

Section: Table 2 Medical Record Characteristics Of Participants By mentioning

confidence: 99%

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Lethal Means Access and Assessment Among Suicidal Emergency Department Patients

et al. 2016

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Background Reducing access to lethal means (especially firearms) might prevent suicide, but counseling of at-risk individuals about this strategy may not be routine. Among emergency department (ED) patients with suicidal ideation or attempts (SI/SA), we sought to describe home firearm access and examine ED provider assessment of access to lethal means. Methods This secondary analysis used data from the Emergency Department Safety Assessment and Follow-up Evaluation, a 3-phase, 8-center study of adult ED patients with SI/SA (2010-2013). Research staff surveyed participants about suicide-related factors (including home firearms) and later reviewed the ED chart (including documented assessment of lethal means access). Results Among 1358 patients with SI/SA, 11% (95%CI 10-13%) reported ≥1 firearm at home; rates varied across sites (range: 6% to 26%) but not over time. On chart review, 50% (95%CI 47-52%) of patients had documentation of lethal means access assessment. Frequency of documented assessment increased over study phases (40% to 60%, p<0.001) but was not associated with state firearm ownership rates. Among the 337 (25%, 95%CI 23-27%) patients discharged to home, 55% (95%CI 49-60%) had no documentation of lethal means assessment; of these, 13% (95%CI 8-19; n=24) actually had ≥1 firearm at home. Among all those reporting ≥1 home firearm to study staff, only half (50%, 95%CI 42-59) had provider documentation of assessment of lethal means access. Conclusions Among these ED patients with SI/SA, many did not have documented assessment of home access to lethal means, including patients who were discharged home and had ≥1 firearm at home.

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Section: Discussionmentioning

confidence: 87%

Section: Table 2 Medical Record Characteristics Of Participants By mentioning

confidence: 99%

Lethal Means Access and Assessment Among Suicidal Emergency Department Patients

et al. 2016

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“…The literature indicates that health professionals, including emergency nurses, predominantly report experiencing less positive feelings (Yaseen et al., ) and more negative attitudes towards patients with suicidal behaviour (Carmona‐Navarro & Pichardo‐martínez, ; Hawton, Casañas I Comabella, Haw, & Saunders, ); these attitudes are further compounded by resistance from health professionals to attend to mental health patients (Bertolote, De Mello‐Santos, & Botega, ). Additionally, studies have shown that emergency department nurses may have moralistic attitudes towards suicide, may blame the suicidal patient (Petrik, Gutierrez, Berlin, & Saunders, ), may be less likely to understand and be sympathetic and may be less likely to verbally interact with suicidal patients (Kishi, Kurosawa, Morimura, Hatta, & Thurber, ).…”

Section: Introductionmentioning

confidence: 99%

Attitudes towards suicidal behaviour and associated factors among nursing professionals: A quantitative study

Vedana

Magrini

Zanetti

et al. 2017

Psychiatric Ment Health Nurs

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Background The attitudes towards suicide of emergency nurses may affect the care provided. However, the factors associated with these attitudes remain unclear. Objective To investigate attitudes towards suicidal behaviour and associated factors among nursing professionals working in emergency settings. Methods A cross-sectional observational study including 28 nurses and 118 who were nursing assistants employed at two emergency services in Brazil was conducted. Data were collected in 2015 using a self-administered sociodemographic questionnaire and the Suicide Behavior Attitude Questionnaire (SBAQ). Results The majority of participants reported having no experience or training in mental health or suicide. They reported more negative feelings towards the patient and a lower self-perception of professional competence regarding suicidal behaviours, and these attitudes seemed to reinforce each other. Nurses who worked in mental health services reported less moralistic/judgemental attitudes. Working in prehospital services was associated with having a lower self-perception of professional competence. There were professionals who reported thinking seriously about committing suicide. Conclusion When combined with support and training, practicing mental health nursing may serve as an opportunity to develop favourable attitudes and emotional competences, and these issues need to be addressed in suicide education strategies.

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“…[13, 14] Studies have also demonstrated past experiences with providers[15], privacy concerns, interactions with other patients, and patient participation during assessment as influences to healthcare utilization in the depressed population. [16] Qualitative data has also revealed several recurring themes with regard to difficulties accessing care. From the perspective of PCPs, concerns over competence were common, such that roughly 41% did not feel confident in providing depression care.…”

Section: Introductionmentioning

confidence: 99%

Access to Care and Depression among Emergency Department Patients

Abar

Hong

Aaserude

et al. 2017

The Journal of Emergency Medicine

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Background The prevalence of depression among patients in the emergency department (ED) is significantly higher than in the general population, making the ED a potentially important forum for the identification of depression and intervention. Concomitant to the identification of depression is the issue of patient access to appropriate care. Objectives This study sought to establish prevalence estimates of potential barriers to care among ED patients and relate these barriers with symptoms of depression. Methods Two medical students conducted brief surveys on all ED patients ≥ 18 years on demographics, perceived access to care, and depression. Results A total of 636 participants were enrolled. The percentage of participants with mild or greater depression was 42%. The majority of patients reported experiencing some barriers to care, with the most prominent being difficulty finding transportation, work responsibilities, and the feeling that the doctor is not responsive to their concerns. Higher depression scores were bivariately associated with higher overall barriers to care mean scores (r=0.44, p<0.001), suggesting that greater symptoms of depression are associated with greater difficulties accessing care. Particularly strong associations were observed between symptoms of depression and difficulty finding transportation, the feeling that the doctor is not responsive to patients’ concerns, embarrassment about a potential illness and confusion trying to schedule an appointment. Conclusion Across all barriers analyzed, there was a greater incidence of depression associated with a greater perception of barriers. These barriers may be used as potential targets for intervention to increase access to health care resources.

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Barriers and facilitators of suicide risk assessment in emergency departments: a qualitative study of provider perspectives

Cited by 83 publications

References 32 publications

Lethal Means Access and Assessment Among Suicidal Emergency Department Patients

Lethal Means Access and Assessment Among Suicidal Emergency Department Patients

Attitudes towards suicidal behaviour and associated factors among nursing professionals: A quantitative study

Access to Care and Depression among Emergency Department Patients

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