Discordance between family report and clinical assessment of suicide attempts: a prospective study from the emergency department

Abstract

BackgroundDeveloping accurate identification methods for individuals with suicide attempts and providing them with follow-up care and supports can be a vital component of all comprehensive suicide prevention strategies. However, because of the difficulties concerning one’s intentions behind injurious behaviour, identifying suicide attempts is a challenge for families and clinicians.AimsThe aim of this study was to investigate the differences between family report and clinical assessment for suicide attempts in the emergency department (ED).MethodsA total of 148 patients with suspected suicide attempts (SSAs) and 148 family caregivers in the ED were enrolled. The suicide risk module of the Chinese version of the MINI International Neuropsychiatric Interview and the self-report measure were used to assess those with SSA’s suicidal behaviours. The Family Adaptability and Cohesion Evaluation Scales and semi-structured interviews were used to investigate the characteristics of suicide risk and demographics of patients with SSA, as well as the rate and influencing factors of omitted suicide attempts reported by family caregivers.ResultsThe underreporting rate for family reported suicide attempts in the ED was 69.0%. The suicide attempts group indicated lower mean scores on perceptions of family resources, adaptability and cohesion. Patients' suicide risk rating (OR =−1.81, 95% CI: −3.87 to −0.33, p=0.036), family satisfaction (OR =−1.11, 95% CI: −2.29 to −0.06, p=0.048), and caregiver’s age (OR =−1.68, 95% CI: −3.10 to −0.48, p=0.010) might be associated with underreporting by families. If patients committed suicide attempts through a falling injury or medication overdose, their families may have misreported the suicide attempt.ConclusionsThe discordance of suicide attempt records between family report and clinical assessment reveals the limitations of family self-reports when identifying suicide attempts. Interviews and observations, together with information from certain diagnoses, should be combined to accurately identify suicide attempters in the ED.

Multiphasic Personality Assessment in a Case Series of Adolescent Patients with Suicidal Ideation and/or Attempts

“…This is in line with the literature that shows low agreement between self-reports and clinician assessments regarding SI [49], with high rates of false positives registered in self-report measures compared to clinical assessment [50]. Moreover, previous studies reported different agreements between the family report and clinical assessment [51]. However, other studies report that participants feel more comfortable disclosing information on suicide-related topics through the relative anonymity of a self-rating scale [52,53].…”

Development of the Life Gatekeeper suicide prevention training programme in China: a Delphi study

“… 4 However, in contrast, a recent study found a relatively low reported rate of suicide attempts by family members in China, which could suggest that recognising suicidal risks remains a crucial challenge for suicide prevention. 5 The Ministry of Education of the People’s Republic of China 6 has recognised the urgent need for promoting mental health services to reduce suicidal risks among Chinese students and advocated a strong collaborative partnership between schools, families and mental health services to improve the ability to intervene in psychological crises among students.…”