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Suicide Risk Assessments: Influences on Clinicians’ Professional Judgment and Confidence in Decision-Making

Cheryl Regehr1*
  • 1 University of Toronto, Faculty of Social Work, Canada

Background According to the WHO, in the year 2000, approximately 1 million people died from suicide. This risk is particularly acute in victims of violence, youth in the criminal justice system, and individuals suffering from virtually all mental illnesses. The assessment of suicide risk is thus a critical skill required of all mental health professionals. 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 consistency with which clinicians make determinations of suicide risk, the degree to which the previous clinicians’ pre-existing emotional state influence professional judgment, and factors influencing clinical confidence. Methods Experienced social workers and social work students conducted suicide risk assessments on two standardized patients performing in scenarios constructed to depict individuals presenting with suicidal ideation, an older chronically depressed woman and an adolescent in crisis. Through random assignment, half the participants interviewed one client first and the other half interviewed the other client first to control for order effects. After indicating their professional judgment regarding the need for hospitalization, participants completed three standardized suicide risk assessment measures. Pre-test measures addressed previous work experiences and current levels of post-traumatic stress, generalized stress and burnout in participants. Self-ratings and qualitative interviews explored participants’ confidence in their judgment of risk. Results This study revealed significant variations in clinical judgments of practitioners assessing suicide risk and divergent views as to whether the patient required hospitalization. While scores on standardized risk assessment measures were the strongest predictor of judgments regarding the need for hospitalization in order to ensure the safety of patient, other influences included clinician age and levels of post-traumatic stress symptoms. However, regardless of the ultimate decision reached, participants were equally confident when recommending either clinical course of action. Conclusions The variation in risk assessment appraisals in this study, despite at times high rates of confidence in risk appraisals, speaks to the need for ongoing training, consultation and increased decision support strategies.

Acknowledgements

This study was generously supported by the Social Sciences and Humanities Research Council of Canada

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Keywords: Suicide, Post-Traumatic Stress Disorder (PTSD), Burnout, Professional, simulation, Social Work, Psychiatric

Conference: ISAD LONDON 2017: Perspectives on Mood and Anxiety Disorders: Looking to the future, London, United Kingdom, 6 Jul - 7 Jul, 2017.

Presentation Type: Poster

Topic: Suicide

Citation: Regehr C (2019). Suicide Risk Assessments: Influences on Clinicians’ Professional Judgment and Confidence in Decision-Making. Front. Psychiatry. Conference Abstract: ISAD LONDON 2017: Perspectives on Mood and Anxiety Disorders: Looking to the future. doi: 10.3389/conf.fpsyt.2017.48.00027

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Received: 26 May 2017; Published Online: 25 Jan 2019.

* Correspondence: Prof. Cheryl Regehr, University of Toronto, Faculty of Social Work, Toronto, Ontario, M5S1A1, Canada, cheryl.regehr@utoronto.ca