定性研究临床医生对预防自杀的焦虑及其对临床实践的影响。

IF 1.8 4区 医学 Q3 HEALTH POLICY & SERVICES Community Mental Health Journal Pub Date : 2024-10-03 DOI:10.1007/s10597-024-01364-6
Jesslyn M Jamison, Megan Brady, Annalisa Fang, Trà-My N Bùi, Courtney Benjamin Wolk, Molly Davis, Rinad S Beidas, Jami F Young, Jennifer A Mautone, Shari Jager-Hyman, Emily M Becker-Haimes
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引用次数: 0

摘要

临床医生在与有自杀风险的患者打交道时所遇到的困扰在文献中已有详细记载,但很少有研究对其在不同临床环境中的普遍性进行研究。我们对从基层医疗机构和门诊心理健康诊所的 26 名临床医生那里收集到的定性数据进行了二次分析,这些临床医生同时为成人和儿童客户提供服务,我们分析了他们对自杀筛查、评估和简短干预的循证实践的看法。我们对定性数据中提到的临床医生的焦虑或情绪反应进行了编码,并收集了简短的定量指标来描述样本的特征。在讨论更广泛的实施障碍时,85% 的参与者自发提到了与向自杀高危人群提供自杀预防实践相关的焦虑或强烈的情绪反应。共同的主题包括:自杀预防技能的自我效能感低、与护理升级相关的困扰、为减轻这种困扰所做的努力,以及与忍受自杀预防工作中固有的不确定性相关的困难。同样,虽然参与者的标准化焦虑评级与非临床标准样本一致,但临床医生在访谈后调查中表示,在筛查自杀风险(中=3.64,标=2.19,范围=0-8)和参与安全规划(中=4.1,标=2.88,范围=1-7)时,存在轻度至中度焦虑。与此相反,调查回答反映出他们在筛查自杀风险(中位数 = 7.66,标度值 = 1.29,范围 = 5.25-10)和参与安全规划(中位数 = 8.25,标度值 = 0.87,范围 = 7-9.5)方面的自我效能感普遍较高。研究结果凸显了临床医生在实施自杀预防实践时普遍存在的困扰,可为今后自杀预防的实施工作提供参考。
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A Qualitative Examination of Clinician Anxiety about Suicide Prevention and Its Impact on Clinical Practice.

Clinician distress about working with patients at risk for suicide is well documented in the literature, yet little work has examined its pervasiveness across clinical settings. We conducted a secondary analysis of qualitative data gathered from 26 clinicians in primary care and outpatient mental health clinics serving both adult and child clients on their perception of evidence-based practice use for suicide screening, assessment, and brief intervention. Qualitative data were coded for any mentions of clinician anxiety or emotional response, and brief quantitative measures were collected to characterize our sample. When discussing broader barriers to implementation, 85% of participants spontaneously mentioned anxiety or heightened emotional responses related to delivering suicide prevention practices to those at risk for suicide. Common themes included low self-efficacy in suicide prevention skills, distress related to escalating care, efforts to alleviate such distress, and difficulty related to tolerating the uncertainty inherent in suicide prevention work. Similarly, while standardized anxiety ratings for participants were consistent with those of non-clinical norming samples, clinicians reported mild to moderate anxiety when screening for suicide risk (M = 3.64, SD = 2.19, Range = 0-8) and engaging in safety planning (M = 4.1, SD = 2.88, Range = 1-7) on post-interview surveys. In contrast, survey responses reflected generally high self-efficacy in their ability to screen for suicide risk (M = 7.66, SD = 1.29, Range = 5.25-10) and engage in safety planning (M = 8.25, SD = 0.87, Range = 7-9.5). Findings highlight pervasiveness of clinician distress when implementing suicide prevention practices and can inform future suicide prevention implementation efforts.

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来源期刊
CiteScore
5.30
自引率
3.70%
发文量
133
期刊介绍: Community Mental Health Journal focuses on the needs of people experiencing serious forms of psychological distress, as well as the structures established to address those needs. Areas of particular interest include critical examination of current paradigms of diagnosis and treatment, socio-structural determinants of mental health, social hierarchies within the public mental health systems, and the intersection of public mental health programs and social/racial justice and health equity. While this is the journal of the American Association for Community Psychiatry, we welcome manuscripts reflecting research from a range of disciplines on recovery-oriented services, public health policy, clinical delivery systems, advocacy, and emerging and innovative practices.
期刊最新文献
Factors Associated with Suicidal Behavior in Adolescents: An Umbrella Review Using the Socio-Ecological Model. Exploring the Relationship Needs of Service Users During Crisis Interventions: A Qualitative Study. Bridging the gap of Inequity in Implementation Science: Adaptations of Group EBPs for those with Serious Mental Illness in the Public Sector. Programmatic and Organizational Barriers and Facilitators to Addressing High-Risk Issues in Supportive Housing and Housing First Programs. Peer Support Workers in Mental Health Services: A Qualitative Exploration of Emotional Burden, Moral Distress and Strategies to Reduce the Risk of Mental Health Crisis.
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