Edinburgh Napier University

  Introduction: Over 800,000 people die by suicide each year, and despite being a global public health issue, limited research exists exploring suicide risk assessment practices in emergency departments. The current thesis investigated emergency department suicide risk assessment practices and clinician experiences in Scotland, to develop guidance to inform the development of a clinically meaningful and feasible suicide risk assessment for these settings which is theoretically underpinned.
Methods: A mixed-method triangulation approach was utilised. Two systematic reviews were conducted to update the risk and protective factor literature. This was followed by a national survey of suicide risk assessment practices in emergency departments. Fifty-one clinicians across 17 emergency departments participated, and six clinicians participated in follow-up semi-structured interviews to investigate their experiences, which were analysed using thematic analysis. Findings of the thesis were triangulated using the ‘following-a-thread’ method, to develop guidance for informing the development of future risk assessment for use in emergency departments.
Results: The systematic reviews identified emerging risk and protective factors including, sexual orientation and internet usage. The survey identified substantial variation in practice between emergency department clinicians. Only 35 (68.6%) participants reported using a suicide risk assessment tool. Importantly, variation was found not only across clinicians and departments, but also within departments, with clinicians based within the same department reporting differing risk assessment practices, indicating both inter- and intra-department suicide risk assessment practice differences. The qualitative analysis of clinician experience established four major themes (current experiences; components of suicide risk assessment; clinical decision-making; suicide risk assessment needs). Triangulation of findings developed recommendations for suicide risk assessment tools and training for emergency departments.
Discussion: The risk and protective factor literature has evolved due to societal changes, and there is substantial variation in suicide risk assessment practices, both across and within emergency departments. Clinicians also find suicide risk assessment challenging. There is a need for consistent training, appropriate and helpful guidelines, and the improvement of risk assessment tools to improve practice. It is recommended that suicide risk assessment tools are developed to align to clinicians’ needs, while taking into account research from the health domain and from related psychological research domains.