Belief in the inevitability of suicide among providers in an emergency department

BACKGROUND: Emergency department (ED) providers frequently care for suicidal patients, but little is known about providers' beliefs concerning suicide preventability through means restriction. We sought to describe ED provider attitudes and behaviors related to suicide prevention and to examine whether attitudes and behaviors vary by provider characteristics.

METHODS: 273 emergency physicians, nurses, technicians, social workers, and psychiatrists at an urban ED received a confidential survey. Providers were asked about suicide inevitability with the following question: “Over 1,000 people have jumped to their deaths from the Golden Gate Bridge. Had there been a barrier that prevented jumping, how many would have found another way to commit suicide?” Stepwise multivariate logistic regression was used to test for associations between belief in suicide inevitability and provider characteristics.

RESULTS: The response rate was 62%. 46% of respondents were male and 55% were physicians, of whom 25% were psychiatrists. 96% of providers reported contact with suicidal patients often or all the time. 35% believed that all the jumpers would have found a lethal suicide alternative, with no difference between psychiatry and ED staff. In multivariate regression, characteristics associated with believing that suicide was inevitable included being a non-physician provider (versus physicians, OR 2.3, 95% Confidence Interval [CI] 1.1-4.7; p≤0.05) and always/often asking suicidal patients about firearm access (versus rarely/never asking, OR 2.1, 95%CI 1.0-4.3; p≤0.05).

CONCLUSIONS: Many ED providers believe suicide is inevitable. Further understanding the basis for these attitudes could facilitate targeted education for providers and enhanced suicide prevention approaches.