Suicide risk assessments: Examining influences on clinicians’ professional judgment.

Abstract

Professional judgment in complex clinical situations such as the assessment of suicide risk encompasses a multifaceted cognitive understanding of the substantive issues, technical expertise, and emotional awareness. This experimental design study investigated the degree to which the previous work-related experiences of clinicians and their preexisting emotional state influence professional judgment regarding acute risk in patients presenting with suicidal ideation. Experienced social workers and social work students conducted suicide risk assessments on 2 standardized patients performing in scenarios constructed to depict individuals presenting with suicidal ideation. This study revealed significant variations in clinical judgments of practitioners assessing suicide risk. While scores on standardized risk assessment measures were the strongest predictor of judgments regarding the need for hospitalization to ensure the safety of the patient, other influences included clinician age and levels of posttraumatic stress symptoms. Mental health clinicians and organizations that employ them should be aware of possible individual influences on professional judgments related to suicide risk.

Suicide Safety Planning: Clinician Training, Comfort, and Safety Plan Utilization

“…Although providers who had had patients die by suicide did not differ in safety plan decision-making, providers who indicated one or more personal exposures to suicide (e.g., losing a friend to suicide, personally experiencing suicidal thoughts or attempts) were more likely to complete safety plans with patients. This result corresponds to studies that indicate that clinical decision-making regarding the treatment of those struggling with suicide-related concerns can be impacted by a myriad of personal factors of the provider [17,18]. Variation in when safety planning is implemented may indicate a need for clearer recommendations regarding which clinical presentations should prompt safety planning and for greater discussion of how attitudes towards suicide may impact patient care.…”

“…Thus, self-administration of safety plans may result in a lower rate of safety plan completion or retention. Finally, prior research indicates that clinical decision-making regarding the treatment of suicide-related behaviors can be impacted by a myriad of personal factors of the provider [17,18]. For example, research has demonstrated that the more religious a clinician reports being, the more likely they are to believe a patient requires hospitalization due to suicide risk [17].…”

“…For example, research has demonstrated that the more religious a clinician reports being, the more likely they are to believe a patient requires hospitalization due to suicide risk [17]. In addition, research indicates that Posttraumatic Stress Disorder symptoms in clinicians are related to lower likelihood of believing a patient is in need of hospitalization [18]. As such, personal factors may also influence when providers decide to initiate safety planning if a clear protocol for when this should occur is not detailed.…”

Staff Exposure to Trauma and the Impact of Trauma-Informed Care

“…Research on workplace related PTSD has primarily examined mental health counsellors, nurses, and emergency responders [19]. In these studies the incidence of symptoms indicating a PTSD diagnosis ranged from social workers at 22.5% [20] to mental health nurses at 14%, and 17% [21] and ranged across all groups from 7% to 44% [22]. Differing methodologies may account for a substantial portion of this range of prevalence and most often, these studies connected traumatic stress symptoms with identifiable, specific, major work-related incidents rather than a wider range of traumatic experiences which most staff in the homeless sector 5 encounter.…”

Ethical and Practical Considerations in the Use of a Predictive Model to Trigger Suicide Prevention Interventions in Healthcare Settings

“…However, clinicians have difficulty considering multiple risk factors at once and appropriately adjusting risk determinations. Furthermore, clinical decision making suffers from significant individual variability, and decision making is influenced by several personal factors, such as provider age, case load, provider marital status, and religiosity (Berman, Stark, Cooperman, Wilhelm, & Cohen, ; Regehr, LeBlanc, Bogo, Paterson, & Birze, ). The use of predictive models may circumvent these concerns and they are less sensitive to individual variability.…”