Suicide risk assessments in psychiatric care: clinical and ethical challenges

Research problem and specific questionsSuicide prevention is a high-priority public health goal.

Assessing patients´ suicide risk is a basis for clinical decisions in psychiatry, including decisions about involuntary care.

However, there is currently a lack of clear evidence on how suicide risk should be assessed and how risk assessments should be used, leading to uncertainty and possible inequality in clinical assessments and decisions.- How are suicide risk assessments conducted and what basis do they provide for clinical decisions, including decisions about involuntary care?- How do patients perceive suicide risk assessments and what is their view on the role of suicide risk assessments in psychiatry?- How do judges perceive suicide risk assessments and what relevance do they have for court decisions regarding involuntary psychiatric care?- How should suicide risk assessments be conducted and how should they be used in healthcare?Data and methods1) Interviews with psychiatrists about how they conduct suicide risk assessments and how they use their assessments.

The data will be analyzed using qualitative content analysis.2) Interviews with patients about their experiences and views of suicide risk assessments.

We will use thematic analysis to analyse the data.3) A survey study based on case vignettes and questions on suicide risk assessments and involuntary psychiatric care. The survey will be sent to Swedish psychiatrists.

We will use descriptive and inferential methods to analyze the results.4) Focus group interviews with judges in the Administrative Courts regarding suicide risk as a reason for involuntary psychiatric care.

We will use qualitative content analysis to analyze the data. 5) Ethical analysis based on studies 1-4 and current research on suicide prediction.

The aim is to present an analysis and an ethical framework to guide assessments of suicide risk in healthcare.Social Relevance and utilisationThe overarching goal of the project is to provide a basis for evidence-based, clinically meaningful, equal, and patient-centered assessments of suicide risk.Plan for project realisationThe project will be conducted over three years by an interdisciplinary research team that includes expertise in psychiatry, medical ethics, and law.

We intend to publish the results in the form of research articles and also to develop a framework for suicide risk assessments to be used as decision support in healthcare