If You Listen, I Will Talk: the Experience of Being Asked About Suicidality During Routine Primary Care
If You Listen, I Will Talk: the Experience of Being Asked About Suicidality During Routine Primary Care
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DOI：
10.1007/s11606-019-05136-x
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发表时间：
2019-10-01
影响因子：
5.7
通讯作者：
Williams, Emily C.
中科院分区：
文献类型：
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作者：
Richards, Julie E.;Hohl, Sarah D.;Williams, Emily C.
背景技术背景：常规的以人群为基础的抑郁症筛查是不断发展的医疗保健模式的重要组成部分，该模式将心理健康护理纳入初级保健。抑郁症工具通常包括有关自杀想法的问题，但患者如何在初级保健经验这些问题是不知道的，可能有影响的准确识别患者的risk. Successtives：探讨患者的经验，常规人口为基础的抑郁症筛查/评估，其次是一些，自杀风险评估和讨论与供应商。设计：定性，访谈为基础的研究。来自Kaiser Permanente华盛顿的37名患者最近在2项患者健康问卷[PHQ]上筛选出抑郁症阳性，并完成了完整的PHQ-9。方法：标准抽样确定了最近完成PHQ-9第九个问题的患者，该问题询问了关于自我伤害的想法的频率。患者通过电话完成了半结构化的访谈，这些访谈被记录和转录。指导和传统的内容分析被用来应用知识从以前的研究和阐明新的信息从访谈;主题分析被用来组织关键内容的整体和跨组的基础上认可的自杀ideation.Key结果：四个主要的组织主题出现在分析：（1）参与者认为被问及自杀倾向是适当的和有价值的，（2）一些参与者描述了他们的生活经历和PHQ-9第九个问题之间的不匹配，（3）自杀倾向的披露涉及权衡希望得到帮助和对负面后果的恐惧，和（4）提供者的关系和倾听和关心的行为促进了关于自杀倾向的讨论。所有参与者都认为被问到自杀想法的问题是合适的，尽管一些透露自杀想法的人描述了经历耻辱的经历，有时他们与自杀保持距离。与可信的提供者直接沟通，他们倾听并表达同情，增强了披露的舒适度。未来的研究应该考虑减少耻辱和鼓励无畏的披露在初级保健患者经历自杀的策略。
BACKGROUND: Routine population-based screening for depression is an essential part of evolving health care models integrating care for mental health in primary care. Depression instruments often include questions about suicidal thoughts, but how patients experience these questions in primary care is not known and may have implications for accurate identification of patients at risk.OBJECTIVES: To explore the patient experience of routine population-based depression screening/assessment followed, for some, by suicide risk assessment and discussions with providers.DESIGN: Qualitative, interview-based study.PARTICIPANTS: Thirty-seven patients from Kaiser Permanente Washington who had recently screened positive for depression on the 2-item Patient Health Questionnaire [PHQ] and completed the full PHQ-9.APPROACH: Criterion sampling identified patients who had recently completed the PHQ-9 ninth question which asks about the frequency of thoughts about self-harm. Patients completed semi-structured interviews by phone, which were recorded and transcribed. Directive and conventional content analyses were used to apply knowledge from prior research and elucidate new information from interviews; thematic analysis was used to organize key content overall and across groups based on endorsement of suicide ideation.KEY RESULTS: Four main organizing themes emerged from analyses: (1) Participants believed being asked about suicidality was contextually appropriate and valuable, (2) some participants described a mismatch between their lived experience and the PHQ-9 ninth question, (3) suicidality disclosures involved weighing hope for help against fears of negative consequences, and (4) provider relationships and acts of listening and caring facilitated discussions about suicidality.CONCLUSIONS: All participants believed being asked questions about suicidal thoughts was appropriate, though some who disclosed suicidal thoughts described experiencing stigma and sometimes distanced themselves from suicidality. Direct communication with trusted providers, who listened and expressed empathy, bolstered comfort with disclosure. Future research should consider strategies for reducing stigma and encouraging fearless disclosure among primary care patients experiencing suicidality.