A systematic review of healthcare professionals' knowledge, attitudes and confidence in relation to suicide

Abstract

Introduction: Suicide is a leading cause of death among adolescents and young adults, globally. Up to 45% of people who die by suicide saw a healthcare professional (HCP) in the previous month (Luoma et al. 2002). Pharmacists frequently encounter people at risk of suicide due to roles in medication supply and access (Murphy et al. 2018).

Aims: To explore HCPs’ knowledge of, attitudes towards, and confidence in caring for people at risk of suicide.

Methods: A systematic search of PubMed, Medline, Embase and PsycINFO for four concepts and their related terms (HCPs, knowledge and attitudes, suicide and confidence with care) was conducted up to April 2016. English primary research publications exploring HCPs’ attitudes, confidence and knowledge in relation to suicide were included. Publications exploring non-suicidal self-injury, assisted suicide, patients’ attitudes and knowledge or suicide among HCPs were excluded.

Results: The search initially yielded 1723 publications. Titles, abstracts and full-texts were screened leaving 48 publications eligible for inclusion, of which 29 were cross-sectional and 19 were intervention studies. Most studies were conducted in the US (n=11) or Japan (n=6) and explored nurse’s (n=30) and non-psychiatrist physicians’ (n=20) knowledge, attitudes and/or confidence. No studies explored these constructs among pharmacists. Studies exploring suicide education and training programs illustrated improvements in knowledge, confidence and attitudes, yet, the sustainability of improvements was unclear. HCPs’ attitudes were affected by their religious, social, political and cultural beliefs, and, their personal experience with suicide. The impact on patient outcomes was not explored.

Discussion: Attitudes, knowledge and confidence are interrelated concepts that may affect HCPs’ care for people at risk of suicide. Training and education are essential for non-specialist HCPs at the forefront of mental healthcare. Further research is required to explore how these concepts ultimately affect care and potentially lead to better patient outcomes.