title: How do healthcare professionals interview patients to assess suicide risk?
abstract: There is little evidence on how professionals communicate to assess suicide risk. This study analysed how professionals interview patients about suicidal ideation in clinical practice.
  
  
  
  Three hundred nineteen video-recorded outpatient visits in U.K. secondary mental health care were screened. 83 exchanges about suicidal ideation were identified in 77 visits. A convenience sample of 6 cases in 46 primary care visits was also analysed. Depressive symptoms were assessed. Questions and responses were qualitatively analysed using conversation analysis. χ2tested whether questions were influenced by severity of depression or influenced patients' responses.
  
  
  
  A gateway closed question was always asked inviting a yes/no response. 75% of questions were negatively phrased, communicating an expectation of no suicidal ideation, e.g., "No thoughts of harming yourself?". 25% were positively phrased, communicating an expectation of suicidal ideation, e.g., "Do you feel life is not worth living?". Comparing these two question types, patients were significantly more likely to say they were not suicidal when the question was negatively phrased but were not more likely to say they were suicidal when positively phrased (χ2= 7.2, df = 1, p = 0.016). 25% patients responded with a narrative rather than a yes/no, conveying ambivalence. Here, psychiatrists tended to pursue a yes/no response. When the patient responded no to the gateway question, the psychiatrist moved on to the next topic. A similar pattern was identified in primary care.
  
  
  
  Psychiatrists tend to ask patients to confirm they are not suicidal using negative questions. Negatively phrased questions bias patients' responses towards reporting no suicidal ideation.
authors.affiliation: University of Exeter Medical School, Room 1.05, College House, Exeter, EX1 2 LU, UK. r.mccabe@exeter.ac.uk.
authors.forename: Rose
authors.identifier: 0000-0003-2041-7383
authors.initials: R
authors.lastname: McCabe
authors.affiliation: Live Well Suffolk, 8 Turret Lane, Ipswich, IP4 1DL, UK.
authors.forename: Imren
authors.initials: I
authors.lastname: Sterno
authors.affiliation: Unit for Social and Community Psychiatry, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, UK.
authors.forename: Stefan
authors.initials: S
authors.lastname: Priebe
authors.affiliation: University of Bristol, Office Room 1.05 Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Barnes
authors.affiliation: Plymouth University Peninsula Schools of Medicine and Dentistry, N32, Tamar Science Park, Drake Circus, Plymouth, Devon, PL4 8AA, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Byng
mesh_terms: D000328:Adult; D000368:Aged; D003863:Depression / Q000175:diagnosis; D005260:Female; D006801:Humans; D007406:Interview, Psychological / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011570:Psychiatry; D012307:Risk Factors; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology*; D055815:Young Adult
keywords: Assessment; Communication; Conversation analysis; Mental health care; Mixed methods; Risk; Suicide