Attitudes of doctors and medical students toward patients with suicidal ideation

Rocha, Gabriela do Prado; Araújo Filho, Gerardo Maria de; Ávila, Lazslo Antônio

doi:10.1590/1983-80422020282396

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

PESQUISA • Rev. Bioét. 28 (2) • Apr-Jun 2020 • https://doi.org/10.1590/1983-80422020282396 copy

Attitudes of doctors and medical students toward patients with suicidal ideation

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Considering suicide is a public health problem, this study identified misconceptions about patients at risk of suicide as well as strategies to manage patients and their families, also verifying changes in conceptions and attitudes throughout graduation. We applied a questionnaire with five categories: “medical confidentiality,” “deontology,” “medical negligence,” “graduation,” and “myths and conceptions”. One hundred and twenty-six subjects participated in the research: 45 (35.7%) first-year medical students, 48 (38.1%) interns, and 33 (26.2%) doctors. The variables were analyzed, and the difference between groups was significant for 15 questions (62.5%). In one question (myths and conceptions) the answers were distant from the expected, and in two questions (myths and conceptions, deontology) the result did not give adequate information. We observed improvements at medical graduation for most of the studied aspects; among the deficiencies, we highlight those related to compulsory notification, electroconvulsive therapy, and the responsibility of doctors.

Suicide; Ethics; Malpractice; Education-Medicine

Characteristics	n	%
Gender
Male	19	57.6
Female	14	42.4
Workplace
Urgency/Emergency	7	21.2
Intensive care unit	2	6.1
Oncology	9	27.3
Medical clinic infirmary	11	33.3
General surgery infirmary	1	3.0
Psychiatry	15	45.5
Occupational situation
Preceptor	8	24.2
Resident
First year	8	24.2
Second year	11	33.3
Third year	5	15.2
Fourth year	1	3.0
Patient with suicidal ideation / week
None	2	6.1
1 to 5	25	75.8
6 to 10	6	18.2
11 to 15	1	3.0
Patient with suicide attempt / week
None	3	9.1
1 to 5	29	87.9
6 to 10	1	3.0

Questions
Medical confidentiality
11. The breach of medical secrecy in situations involving suicide can be considered ethical and legal.
18. When identifying a patient at medium risk of committing suicide, the proper conduct would be to request permission to contact family, friends and/or colleagues and explain the situation without alarm or understate, giving only the necessary information and preserving the confidentiality of other information on the particularities of the individual.
22. According to the Brazilian Code of Medical Ethics, the doctor shall keep confidential information that he knows about in the performance of his duties . Medical confidentiality must be respected even in situations in which the patient has suicidal ideation and is at risk of committing suicide.
Deontology
12. The risk assessment for suicide should be made for all patients, regardless of the presence of explicit suicidal complaints.
19. Urgency/emergency: 24-hour surveillance should be structured by someone from the health care team or caregiver, if evaluated as qualified, until medical reassessment. Objects that can be used to injure oneself or others (knives, sharp instruments, medicines, belts and ropes) should be removed from the patient’s access, and their belongings should be searched for these items. Doors, including the bathroom, should not be locked.
21. Since June 2014, the National List of Compulsory Notification of diseases, injuries and public health events in public and private health services, throughout the national territory, includes attempted suicide as an immediate compulsory notification within 24 hours from the knowledge of the occurrence.
23. In cases of high risk of suicide, the doctor may hospitalize the patient against his will in order to ensure his life.
24. It must be ensured that the person who has just made a suicide attempt is immediately put on treatment to reduce the risk of re-attempting and completing suicide.
Medical negligence
1. Suicide is an individual decision, since one has the full right to exercise free will.
5. When an individual shows signs of improvement or survives a suicide attempt, they are out of danger.
10. Patients who are severely depressed, but cognitively intact, may be considered competent to refuse antidepressant medication.
13. Failure to examine the patient’s propensity to commit suicide or to implement an appropriate precautionary plan after the potential for suicide is predicted may lead to professional liability for injury to the individual in a suicide attempt.
Graduation
26. Were you trained during your graduation to treat patients with suicidal ideation?
27. Do you feel prepared to attend patients with suicidal behavior (thoughts, attempts, planning)?
Myths and conceptions
2. When a person thinks about committing suicide, they will risk suicide for the rest of their life.
3. People who threaten to kill themselves will not do so, they just want to get attention.
4. If a person felt depressed and was thinking about committing suicide, and in the next moment feels better, it usually means that the problem is over.
6. We should not talk about suicide as this can increase the risk.
7. Effective treatment of mental illness is the most important pillar of suicide prevention. After the treatment of mental illness, the desire to kill oneself disappears.
8. Most suicidal people speak or show signs about their ideas of death.
9. Talking to someone about it can ease the anguish and tension that suicidal thoughts bring.
14. Every patient who talks about suicide has potential risk and deserves special investigation and attention.
15. The verbal approach can be as or more important than medication.
16. Although most people at risk of suicide have some mental disorder, most do not seek a mental health professional.
17. Electroconvulsive therapy is still the most effective treatment for depression, being reserved primarily for selected cases such as severe depressions, refractory depressions, depressions with psychotic symptoms and depressions with high risk of suicide.
20. Suicide prevention should start only in centers with a focus on mental health.

Questions	Expected responses	FG				IG				DG				p -value
Questions	Expected responses	Average	Median	Mode		Average	Median	Mode		Average	Median	Mode		FG/IG	FG/DG	IG/DG
Q1	1	3.09	3	4	35.6%	2.73	3	2	39.6%	2.36	2	2	60.6%	ns	<0.05	ns
Q2	2	2.27	2	2	60.0%	2.73	2	2	43.8%	3.30	4	4	42.4%	ns	<0.05	ns
Q3	1	1.76	2	2	46.7%	1.21	1	1	79.2%	1.70	1	1	51.5%	<0.05	ns	ns
Q4	1	1.89	2	2	60.0%	1.71	2	2	56.3%	1.85	2	2	57.6%	0.534
Q5	1	1.60	2	2	53.3%	1.42	1	1	58.3%	1.39	1	1	63.6%	0.1267
Q6	1	1.36	1	1	66.7%	1.27	1	1	75.0%	1.27	1	1	75.8%	0.4895
Q7	5	2.38	2	2	60.0%	2.54	2	2	54.2%	2.67	2	2	48.5%	0.5067
Q8	5	2.78	2	2	44.4%	3.98	4	4	43.8%	3.76	4	5	36.4%	<0.05	<0.05	ns
Q9	5	3.89	4	4	73.3%	4.21	4	4	66.7%	4.33	4	4	57.6%	ns	<0.05	ns
Q10	1	2.51	3	3	44.4%	2.10	2	2	45.8%	2.00	2	2	48.5%	ns	<0.05	ns
Q11	5	2.56	3	3	40.0%	3.48	4	4	45.8%	3.97	4	4	63.6%	<0.05	<0.05	ns
Q12	5	3.67	4	4	61.4%	3.15	4	4	45.8%	3.52	4	4	45.5%	0.1047
Q13	5	2.84	3	2.3	40.0%	3.00	3	3	37.5%	2.97	3	4	42.4%	0.599
Q14	5	3.58	4	4	62.2%	4.21	4	4	52.1%	4.18	4	4	48.5%	<0.05	<0.05	ns
Q15	5	4.29	4	4	57.8%	4.38	4	4	62.5%	4.18	4	4	54.5%	0.5781
Q16	5	3.89	4	4	73.3%	4.25	4	4	56.3%	3.42	4	4	66.7%	<0.05	ns	ns
Q17	5	2.78	3	3	82.2%	3.38	3	3.4	33.3%	3.42	3	3	30.3%	<0.05	<0.05	ns
Q18	5	3.78	4	4	71.1%	3.69	4	4	62.5%	3.67	4	4	66.7%	0.9293
Q19	5	3.64	4	4	57.8%	3.88	4	4	58.3%	4.21	4	4	54.5%	ns	<0.05	ns
Q20	1	2.18	2	2	73.3%	1.52	1	1	58.3%	1.45	1	1	54.5%	<0.05	<0.05	ns
Q21	5	3.16	3	3	80.0%	3.48	3	3	45.8%	3.64	4	4	39.4%	ns	<0.05	ns
Q22	1	2.91	3	2	40.0%	2.23	2	2	56.3%	1.82	2	2	51.5%	<0.05	<0.05	ns
Q23	5	3.07	3	3	44.4%	3.73	4	4	52.1%	3.94	4	4	51.5%	<0.05	<0.05	ns
Q24	5	3.96	4	4	64.4%	4.06	4	4	60.4%	4.24	4	4	75.8%	0.2071

Conselho Federal de Medicina SGAS 915, lote 72, CEP 70390-150, Tel.: (55 61) 3445-5932, Fax: (55 61) 3346-7384 - Brasília - DF - Brazil
E-mail: bioetica@portalmedico.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence Lazslo Antônio Ávila – Faculdade de Medicina de São José do Rio Preto. Av. Brigadeiro Faria Lima, 5.416 CEP 15090-000. São José do Rio Preto/SP, Brasil