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Suicide Risk Assessment Often Inaccurate in Ambiguous Cases Findings Suggest a Need for Better Risk Assessment Training
March 16, 2011 (Vienna, Austria) — Faced with ambiguous cases, mental health professionals (MHPs) often inaccurately classify patients’ suicide risk, new research shows.
Presented here at EPA 2011: 19th European Congress of Psychiatry, UK investigators found obviously high- or low-risk scenarios produced a predictable consensus of opinion among MHPs with respect to suicide risk. However, an ambiguous or incomplete scenario produced more variation in risk classification.
“The results mean that a group of MHPs may be misclassifying some of their patients, who are at high risk of suicide, as being at low or medium risk,” Julian Beezhold, FRCPsych, consultant in emergency psychiatry at Hellesdon Hospital in Norwich, United Kingdom, told Medscape Medical News.
The data also identify the need for better risk assessment training, with a special focus on MHPs who assume the risk is low when presented with incomplete or ambiguous information, Dr. Beezhold added.
Lack of Guidance
According to investigators, suicide risk assessment accounts for a significant part of the MHPs’ workload, and a large body of research has examined the efficacy of various methods of suicide risk assessment. Further, a significant amount of effort has been devoted to developing suicide risk assessment training to improve clinical outcomes.
To date, the various assessment methods available include the actuarial approach, which is based on algorithms and objective procedures; the clinical approach, which is more subjective, intuitive, and based on clinical experience; and a structured approach, which combines the actuarial and clinical approach, which is widely viewed as the preferred approach.
None of these methods, however, provide clinicians with guidance on how to respond to an ambiguous scenario.
A total of 720 MHPs from a broad range of disciplines were asked to assess suicide risk for 10 clinical scenarios developed to provide a mixture of high-, medium-, and low-risk cases. In some of the scenarios, the available information was incomplete or ambiguous.The study examined suicide risk for various clinical scenarios with a particular focus on ambiguous cases.
The following is an example of an incomplete and ambiguous scenario that was included in the study:
“A 55-year-old man has been sent in by a community practitioner without a letter. He does not respond to your questions and avoids eye contact. You notice that he is short of breath.”
About 20% of MHPs suggested that they didn’t know how to classify a patient with ambiguous or incomplete information. About 40% of MHPs were more cautious and opted for a high-risk classification. The remaining 40% were less cautious and assumed that the patient was at low risk for suicide.
“The best response in an uncertain scenario is to acknowledge that the lack of information and ambiguity may mask a higher-risk patient, and therefore clinicians should proceed more cautiously,” Dr. Beezhold said.
“For example, they should take more time in order to complete a more thorough risk assessment. A lack of information in a given clinical scenario may prevent individuals from using a combined actuarial/clinical judgment-based method, such as a suicide rating scale, in their assessment of suicide risk. Without objective information, clinicians may have to rely on judgment alone,” he said.
The MHPs in the study included junior and senior psychiatrists, mental health nursing staff, clinical psychologists, nursing assistances, and therapists working at the Norfolk & Waveney Mental Health Care NHS Foundation Trust, which provides a complete range of mental health care to roughly 1 million people.
Dr. Beezhold pointed out the study clearly identifies a need to target training more precisely according to individual response to ambiguity.
Finally, he noted that more studies are needed to better explain the discrepancy in responses to suicide risk scenarios among MHPs.
“The more information we have, the better we can predict suicidality,” he said.
If you or a loved one are suffering from depression or have suicidal thoughts, please seek professional help.
Dr. Beezhold has disclosed no relevant financial relationships.
EPA 2011: 19th European Congress of Psychiatry: Abstract P03-458. Presented March 15, 2011.
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