Factors influencing suicide risk assessment clinical practice: protocol for a scoping review

Abstract

IntroductionEvery year, suicide accounts for nearly 800 000 deaths worldwide. Appropriate risk assessment and intervention are imperative since evidence demonstrates that a large proportion of those who die by suicide visit health professionals prior to their death. Much previous research has focused on identifying patient-level risk factors that can improve the risk assessment process through scales and algorithms. However, the best practice guidelines emphasise the importance of clinical interviews and prioritise the clinician’s final judgement. The purpose of this review is to (1) understand the clinician and organisational level barriers and facilitators that influence a clinician’s assessment of suicide risk, (2) identify the types of biases that exist within this process and (3) list any evidence-based training protocols and educational initiatives to aid (or support) clinicians with this process.Methods and analysisThis scoping review protocol uses the Arksey and O’Malley framework, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines for scoping reviews. Literature will be identified using a multidatabase search strategy developed in consultation with a medical librarian. The proposed screening process consists of a title and abstract scan, followed by a full-text review by two reviewers to determine the eligibility of articles. Studies outlining any factors that affect a clinician’s suicide risk assessment process, ranging from individual experience and behaviours to organisational level influences, will be included. A tabular synthesis of the general study details will be provided, as well as a narrative synthesis of the extracted data, organised into themes using the Situated Clinical Decision-Making framework.Ethics and disseminationEthical approval is not required for this review. Results will be translated into educational materials and presentations for dissemination to appropriate knowledge users. Knowledge outputs will also include academic presentations at relevant conferences, and a published, peer-reviewed journal article.

Characteristics of Suicide Prevention Apps: A Content Analysis of Apps Available in Canada and the United Kingdom

“…Briefly, basic descriptive data were extracted (e.g., name, genre, developer of the app), alongside security (e.g., whether password protection available), and design (e.g., whether the app could be personalized) features. App content was examined using the Essential Features Framework [18]. Data extraction was performed by one researcher (specific person dependent on app location and whether the was available on Apple or Android) and was then verified by a second reviewer.…”

“…In recent years efforts have been made to design tools to allow systematic assessment of suicide prevention apps. One such tool is the Essential Features Framework [18] which aims to facilitate assessment of apps based on content, features, and design. This framework was developed using a systematic review of articles examining development, implementation, feasibility, or effectiveness of suicide prevention apps, where features of apps discussed were synthesized using thematic analysis.…”

An approach for Risk Assessment Score of Suicide Attempt (RASSA)

“…Despite the value of these scales in the assessment of suicidal risk, they require the patient's cooperation and prior medical intervention, limiting their scope of application. Yet suicide remains a leading cause of death, and there is a persistent need for well-designed clinical instruments that allow us to make progress in establishing risk factors [4] and improving suicide prediction [5]. To this end, new and creative approaches are required [6].…”

Epidemiological Trend, Risk Factors, Prevention and Treatment Strategies of Self-directed Violent Behavior: A Critical Appraisal of Relevant Literature

“…The determinants, early warning signs and prevention of suicide might be addressed using universal, selective and targeted/indicated strategies [7,23]. On clinical ground, neuropsychiatric disorders, genetic propensity, previous suicidal attempts, family history of suicide, sexual abuse, trauma and maltreatment, chronic physical diseases, cancers, chronic pain, hopelessness and their psychiatric comorbidities are major contributors to the pool of suicide and suicidal attempts across the world [24][25][26][27][28][29]. Concerning healthcare systems at three levels of care, barriers against timely access to healthcare and mental health (MH) help-seeking pathways, shortage of mental health (MH) professionals, social stigma, relative lack of Primary Mental Health Care (PMHC) services in the community (hybrid model services), inadequate supply of psychotropics, and lack of proper psychiatric referral system from PMHC to secondary or tertiary mental health care (MHC) system further add considerable variance to the suicide rate and preventable fatalities [7,10,[30][31][32][33][34].…”