TY - JOUR
T1 - Examination of physician factors influencing psychiatric assessment of acutely suicidal patients
AU - Chacko, Mason
AU - Job, Asha
AU - Kim, Diane J.
AU - (Peter) Hong, Houlin
AU - Fontecha-Hernandez, Jeisson
AU - Durand, Dante
AU - Hasan, Abdullah
AU - Cáceda, Ricardo
N1 - Publisher Copyright:
© 2021
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/3
Y1 - 2021/3
N2 - Suicide risk assessment is a subjective process and remains a clinical challenge in psychiatry. We aimed to examine physicians’ characteristics that influence management of acutely suicidal patients. In a cross-sectional design, we performed an anonymous internet survey of psychiatry residents and attendings from four academic centers. Gender, years of experience, practice setting, prior patient suicide, and personal exposure to suicide were characterized. Participants were presented with three clinical vignettes and asked to rate suicide risk and clinical disposition. The relationship between responses to the vignettes and physician characteristics were examined with generalized linear models. Fifty-four residents and 49 attendings completed the survey. Four (7%) residents and 24 (49%) attendings had patients die by suicide, whereas 32 (59%) and 36 (74%), respectively, knew somebody outside their practice who died by suicide. Among residents, lower rating of acute suicide risk was associated with prior exposure to non-patient suicide. Less hospitalization chosen by attendings was associated with greater perceived difficulty of suicide risk assessment. In the combined resident and attending sample, less proneness to hospitalize was associated with number of previous patients die by suicide and with outpatient practice. Our results suggest that previous exposure to suicide is associated with more risk-averse management.
AB - Suicide risk assessment is a subjective process and remains a clinical challenge in psychiatry. We aimed to examine physicians’ characteristics that influence management of acutely suicidal patients. In a cross-sectional design, we performed an anonymous internet survey of psychiatry residents and attendings from four academic centers. Gender, years of experience, practice setting, prior patient suicide, and personal exposure to suicide were characterized. Participants were presented with three clinical vignettes and asked to rate suicide risk and clinical disposition. The relationship between responses to the vignettes and physician characteristics were examined with generalized linear models. Fifty-four residents and 49 attendings completed the survey. Four (7%) residents and 24 (49%) attendings had patients die by suicide, whereas 32 (59%) and 36 (74%), respectively, knew somebody outside their practice who died by suicide. Among residents, lower rating of acute suicide risk was associated with prior exposure to non-patient suicide. Less hospitalization chosen by attendings was associated with greater perceived difficulty of suicide risk assessment. In the combined resident and attending sample, less proneness to hospitalize was associated with number of previous patients die by suicide and with outpatient practice. Our results suggest that previous exposure to suicide is associated with more risk-averse management.
KW - clinical decision making
KW - clinical vignettes
KW - patient suicide
KW - risk assessment
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U2 - 10.1016/j.psychres.2021.113736
DO - 10.1016/j.psychres.2021.113736
M3 - Article
C2 - 33486272
AN - SCOPUS:85099614937
VL - 297
JO - Psychiatry Research
JF - Psychiatry Research
SN - 0165-1781
M1 - 113736
ER -