Asking about self-harm and suicide in primary care: Moral and practical dimensions
Asking about self-harm and suicide in primary care: Moral and practical dimensions
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DOI：
10.1016/j.pec.2020.09.037
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发表时间：
2021-03-22
影响因子：
3.5
通讯作者：
McCabe, Rose
中科院分区：
文献类型：
--
作者：
Ford, Joseph;Thomas, Felicity;McCabe, Rose
目的：自我伤害和自杀是与经历心理健康状况的人讨论的重要话题。本研究探讨了这种讨论在实践中是如何展开的，以及它们对病人和医生的道德和实际影响是如何体现的。方法：使用会话分析（CA）来检查20个记录的例子，医生关于自残和自杀的问题以及他们随后与病人的讨论。倾向于将关于自残的问题框定为“不”的回答，将自残和自杀的问题合并在一起，限制围绕家人和朋友提供的保护因素的对话，限制对患者经历和担忧的讨论。在风险评估背景下，有关思想和行动的封闭问题导致错过了验证令人痛苦的想法的机会。肯定回答的患者往往这样做的方式，远离自己的负面污名与suicid.Conclusion：问题的措辞，沿着负面污名，可以使患者难以谈论自我伤害。实践的影响：讨论可以提高询问自我伤害和自杀分开，鼓励讨论时的反应是模棱两可的，验证痛苦的想法。负面的耻辱感可以通过探索患者想要活下去的积极原因来消除。(C)2020作者由爱思唯尔公司出版
Objective: Self-harm and suicide are important topics to discuss with people experiencing mental health conditions. This study explores how such discussions unfold in practice, and how their moral and practical repercussions manifest for patients and doctors.Methods: Conversation analysis (CA) was used to examine 20 recorded examples of doctors' questions about self-harm and suicide and their ensuing discussions with patients.Results: A tendency to frame questions about self-harm towards a 'no' response, to amalgamate questions around self-harm and suicide, and to limit dialogue around the protective factors offered by family and friends restricted discussion of patients' experiences and concerns. Closed questions about thoughts and actions in the context of risk assessment resulted in missed opportunities to validate distressing thoughts. Patients responding affirmatively often did so in a way that distanced themselves from the negative stigma associated with suicide.Conclusion: The wording of questions, along with negative stigma, can make it difficult for patients to talk about self-harm.Practice implications: Discussions could be improved by asking about self-harm and suicide separately, encouraging discussion when responses are ambiguous and validating distressing thoughts. Negative stigma could be countered by exploring patients' positive reasons for wanting to stay alive. (C) 2020 The Authors. Published by Elsevier B.V.