Background The use of digital technology can help people access information and provide support for their mental health problems, but it can also expose them to risk, such as bullying or prosuicide websites. It may be important to consider internet-related risk behavior (digital risk) within a generic psychiatric risk assessment, but no studies have explored the practice or acceptability of this among psychiatrists. Objective This study aimed to explore psychiatry trainees’ experiences, views, and understanding of digital risk in psychiatry. We predicted that clinician awareness would be highest among trainees who work in child and adolescent mental health services. Methods We conducted a cross-sectional survey of psychiatry trainees attending a UK regional trainees’ conference to investigate how they routinely assess patients’ internet use and related risk of harm and their experience and confidence in assessing these risks. We conducted focus groups to further explore trainees’ understandings and experiences of digital risk assessment. Descriptive statistics and chi-squared tests were used to present the quantitative data. A thematic analysis was used to identify the key themes in the qualitative data set. Results The cross-sectional survey was completed by 113 out of 312 psychiatry trainees (response rate 36.2%), from a range of subspecialties and experience levels. Half of the trainees (57/113, 50.4%) reported treating patients exposed to digital risk, particularly trainees subspecializing in child and adolescent psychiatry (17/22, 77% vs 40/91, 44%;P=.02). However, 67.3% (76/113) reported not feeling competent to assess digital risk. Child and adolescent psychiatrists were more likely than others to ask patients routinely about specific digital risk domains, including reckless web-based behavior (18/20, 90% vs 54/82, 66%; P=.03), prosuicide websites (20/21, 95% vs 57/81, 70%; P=.01), and online sexual behavior (17/21, 81% vs 44/81, 54%; P=.02). Although 84.1% (95/113) of the participants reported using a proforma to record general risk assessment, only 5% (5/95) of these participants prompted an assessment of internet use. Only 9.7% (11/113) of the trainees had received digital risk training, and 73.5% (83/113) reported that they would value this. Our thematic analysis of transcripts from 3 focus groups (comprising 11 trainees) identified 2 main themes: barriers to assessment and management of digital risk, and the double-edged sword of web use. Barriers reported included the novelty and complexity of the internet, a lack of confidence and guidance in addressing internet use directly, and ongoing tension between assessment and privacy. Conclusions Although it is common for psychiatrists to encounter patients subject to digital risk, trainee psychiatrists lack competence and confidence in their assessment. Training in digital risk and the inclusion of prompts in standardized risk proformas would promote good clinical practice and prevent a potential blind spot in general risk assessment.

People who complete suicide are in contact with general medical services frequently in the year before their death. The high rate of medical contacts in the year before suicide and evidence that psychiatric conditions are under-diagnosed suggests that a significant opportunity for suicide prevention exists in the general medical setting. This article makes several recommendations to seize this opportunity with the aim of reaching as many patients as possible, ensuring early diagnosis and treatment of mental health problems and providing compassionate care to those who most need it.

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BACKGROUND The use of digital technology can help people access information and support for their mental health problems but can also expose them to risk, such as bullying or pro-suicide websites. It may be important to consider internet-related risk behaviour (digital risk) within a generic psychiatric risk assessment, but no studies have explored the practice or acceptability of this among psychiatrists. OBJECTIVE We sought to explore psychiatry trainees’ experiences, views, and understanding of digital risk in psychiatry. We predicted that clinician awareness would be highest amongst trainees who work in child and adolescent mental health services. METHODS We conducted a cross-sectional survey of psychiatry trainees attending a UK regional trainees’ conference to investigate how they routinely assess patients’ internet use and related risk of harm, and their experience and confidence in assessing these risks. We then conducted focus groups to further explore trainees’ understandings and experiences of digital risk assessment. We used descriptive statistics and chi-squared tests to present quantitative data and used thematic analysis to identify key themes in the qualitative dataset. RESULTS The cross-sectional survey was completed by 113 psychiatry trainees (response rate 36%), from a range of sub-specialties and experience levels. Half of trainees (50%) reported treating patients exposed to digital risk, particularly trainees sub-specialising in child and adolescent psychiatry (77% versus 44%, p=0.02). However 67% reported not feeling competent to assess digital risk. Child and adolescent psychiatrists were more likely than others to ask patients routinely about specific digital risk domains, including reckless online behaviour (90% versus 66%, p=0.03), pro-suicide websites (95% v 70%, p=0.01) and online sexual behaviour (81% versus 54%, p=0.02). Although 84% participants reported using a proforma to record general risk assessment, only 5% of these prompted assessment of internet use. Only 9% of trainees had received digital risk training and 73% overall reported they would value this. Our thematic analysis of transcripts from three focus groups (comprising n=11 trainees) identified two main themes: barriers to assessment and management of digital risk, and the double-edged sword of online use. Barriers reported included the novelty and complexity of the internet, a lack of confidence and guidance in addressing internet use directly, and an ongoing tension between assessment and privacy. Child and adolescent psychiatrists most commonly reported anxiety about compromising their rapport with younger patients in the pursuit of a thorough digital risk assessment. Despite reporting many experiences of digital risks, all trainees felt that digital engagement brought their patients many discernable benefits by promoting social inclusion and connecting them with society and culture. CONCLUSIONS Despite it being common for psychiatrists to encounter patients subject to digital risk, trainee psychiatrists lack competence and confidence in its assessment. Training in digital risk, and the inclusion of prompts in standardized risk proformas, would promote good clinical practice and prevent a potential blind spot in general risk assessment.