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Communicating about suicide: How do healthcare professionals ask sensitive questions about suicide?


Staff, Students, Alumni, Academics

The Centre for Mental Health Research welcomes Rose McCabe, Professor of Clinical Communication at the University of Exeter, to the School of Health Sciences. Her research focuses on how the meaning of peoples’ experiences and shared understanding is negotiated between healthcare professionals and the people they treat. She records professional-patient encounters and micro-analyses verbal and nonverbal communication. She also works on translating these findings into novel interventions to improve communication and patient outcomes in mental healthcare.

About the lecture

Background: 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.

Methods: 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. χ2 tested whether questions were influenced by severity of depression or influenced patients’ responses.

Results: 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. 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.

Conclusions: 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.

A light lunch with refreshments will be provided from 12:45.

For further information regarding the seminar contact Verity Sullivan

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When & where

12.45pm - 2.00pmMonday 23rd October 2017

MG26 Myddelton Street Building City, University of London 1 Myddelton Street London EC1R 1UW United Kingdom

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