title: Psychiatrists' experiences of suicide assessment.
abstract: BACKGROUND
  Clinical guidelines for suicide prevention often stress the identification of risk and protective factors as well as the evaluation of suicidal intent. However, we know very little about what psychiatrists actually do when they make these assessments. The aim was to investigate psychiatrists' own accounts of suicide assessment consultations, with a focus on their behaviors, attitudes and emotions.
  
  
  METHODS
  Semi-structured in depth interviews were carried out with a purposive selection of 15 psychiatrists.
  
  
  RESULTS
  Thematic analysis revealed three main themes: understanding the patient in a precarious situation, understanding one's own reactions, and understanding how the doctor-patient relationship impacted on risk assessment and management decisions. Emotional contact and credibility issues were common subthemes that arose when the respondents talked about trying to understand the patient. The psychiatrists stressed the semi-intuitive nature of their assessments. Problems related to the use of risk factor assessments and rating scales were apparent. Assessment consultations could evoke physical and emotional symptoms of anxiety, and concerns about responsibility could lead to repressive management decisions. In situations of mutual trust, however, the assessment consultation could kick-start a therapeutic process.
  
  
  CONCLUSIONS
  This study highlights psychiatrists' experiences in clinical suicide assessment situations. Findings have implications for professional development as well as for service delivery.
authors.affiliation: Section of Psychiatry and Neurochemistry, Gothenburg University, Blå Stråket 15, 41543, Gothenburg, Sweden. margda.waern@neuro.gu.se.
authors.forename: Margda
authors.identifier: http://orcid.org/0000-0002-8330-6915
authors.initials: M
authors.lastname: Waern
authors.affiliation: Department of Psychology, Umeå University, Umeå, Sweden.|Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden.
authors.forename: Niclas
authors.initials: N
authors.lastname: Kaiser
authors.affiliation: Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden.
authors.forename: Ellinor Salander
authors.initials: ES
authors.lastname: Renberg
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D065840:Protective Factors; D011570:Psychiatry; D036301:Qualitative Research; D018570:Risk Assessment; D012307:Risk Factors; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology; D000092864:Suicide Prevention
keywords: Involuntary care; Medical training; Professional development; Psychiatrists’ experiences; Suicide assessment