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Skepticism towards the Swedish vision zero for suicide: interviews with 12 psychiatrists.

ABSTRACT: BACKGROUND:The main causes of suicide and how suicide could and should be prevented are ongoing controversies in the scientific literature as well as in public media. In the bill on public health from 2008 (Prop 2007/08:110), the Swedish Parliament adopted an overarching "Vision Zero for Suicide" (VZ) and nine strategies for suicide prevention. However, how the VZ should be interpreted in healthcare is unclear. The VZ has been criticized both from a philosophical perspective and against the background of clinical experience and alleged empirical claims regarding the consequences of regulating suicide prevention. This study is part of a larger research project in medical ethics with the overarching aim to explore whether the VZ is ethically justifiable. The aim is to enrich the normative discussion by investigating empirically how the VZ is perceived in healthcare. METHODS:Interviews based on a semi-structured interview guide were performed with 12 Swedish psychiatrists. The interviews were analysed with descriptive qualitative content analysis aiming for identifying perceptions of the Vision Zero for Suicide as well as arguments for and against it. RESULTS:Though most of the participants mentioned at least some potential benefit of the Vision Zero for Suicide, the overall impression was a predominant skepticism. Some participants focused on why they consider the VZ to be unachievable, while others focused more on its potential consequences and normative implications. CONCLUSIONS:The VZ was perceived to be impossible to realize, nonconstructive or potentially counterproductive, and undesirable because of potential conflicts with other values and interests of patients as well as the general public. There were also important notions of the VZ having negative consequences for the working conditions of psychiatrists in Sweden, in increasing their work-related anxiety and thwarting the patient-physician relationship.

SUBMITTER: Karlsson P

PROVIDER: S-EPMC5894210 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Skepticism towards the Swedish vision zero for suicide: interviews with 12 psychiatrists.

Karlsson Petter P Helgesson Gert G Titelman David D Sjöstrand Manne M Juth Niklas N

BMC medical ethics 20180410 1

<h4>Background</h4>The main causes of suicide and how suicide could and should be prevented are ongoing controversies in the scientific literature as well as in public media. In the bill on public health from 2008 (Prop 2007/08:110), the Swedish Parliament adopted an overarching "Vision Zero for Suicide" (VZ) and nine strategies for suicide prevention. However, how the VZ should be interpreted in healthcare is unclear. The VZ has been criticized both from a philosophical perspective and against ...[more]

PMID: 29636033

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Project description:ObjectivesThis study aimed to investigate whether violent and non-violent offending were related to elevated risk of suicide. We also investigated whether the risk was higher among those with repeated offences and how experiences of substance misuse and suicide attempt modified the relationship.DesignA nationwide prospective cohort study.SettingA register study of 48 834 conscripted men in 1969/1970 in Sweden followed up during a 35-year period in official registers.ParticipantsA birth cohort of 48 834 men who were mandatory conscripted for military service in 1969/70 at the age of 18-20 years. Possible confounders were retrieved from psychological assessments at conscription and the cohort was linked to mortality and hospitalisation and crime records from 1970 onwards. Estimates of suicide risks were calculated as HR with 95% CIs using Cox proportional regression analyses with adjustment for potential confounding by family, psychological and behavioural factors including substance use and psychiatric disorders.ResultsOf the total cohort, 2671 (5.5%) persons died during the follow-up period. Of these, 615 (23%) persons died due to suicide. Non-violent criminality was evident for 29% and violent criminality for 4.7% of all the participants. In the crude model, the violent offenders had nearly five times higher risk (HR=4.69, 3.56 to 6.19) to die from suicide and non-violent criminals had about two times higher risk (HR=2.08, 1.72 to 2.52). In the fully adjusted model, the HRs were still significant for suicide in the non-violent group.ConclusionsExperiences of violent or non-violent criminality were associated with increased risk of suicide. Comorbidity with alcohol and substance use and psychiatric disorders modified the risk, but the suicide risk remained significantly elevated for non-violent criminals. It is crucial to identify offenders and especially repeated offenders who also suffer from alcohol or substance misuse and psychiatric illness in clinical settings in order to prevent suicide.

Project description:Because it has been associated with significant increases [through the Werther Effect (WE)] or decreases [through the Papageno Effect (PE)] of suicide rates, media coverage of suicide-related events is recognized as a prevention leverage. Unfortunately, the recommendations that the World Health Organization (WHO) has published to help journalists reporting on suicide remain poorly applied. The Mini Media Training (MMT) is a short media training session designed to increase psychiatrists' ability to communicate about suicide during interviews. We aimed at assessing the effect of the MMT on psychiatrists' ability to help journalists complying with the WHO recommendations. From June 2017 to December 2019, 173 physicians and residents in psychiatry were recruited during French national congresses. At baseline (T0) and 1 and 3 months later (T1), participants received the MMT, which consisted in a simulated interview where they we asked to answer a journalist about a mock suicide. Communication skills were measured with a score summing the number of delivered pieces of advice in relation to the WHO recommendations, with a maximum score of 33. A weighted score was also derived based on the degree of directivity needed for the participant to provide these items, again with a possible maximum of 33. A total of 132 psychiatrists participated in the study at T0 and T1. Both the weighted and unweighted score significantly increased from T0 to T1 (d = +2.08, p < 0.001, and d = +1.24, p < 0.001, respectively). Having a history of contacts with journalists, a short professional experience (<3 years) and prior knowledge of the WE, PE, and WHO recommendations were significantly associated with greater unweighted and weighted scores at baseline. The latter two variables also predicted greater T0-T1 improvement of the weighted score. These results suggest that the MMT could be effective for improving the ability of psychiatrists to guide journalists toward more responsible media coverage of suicide. As a short, easy to implement educational activity, the MMT could therefore be considered in association with other measures to help media professionals mitigating the WE and promoting the PE.

Project description:Objective: The high didactic potential of Virtual Reality (VR) contrasts with the point of view of students that the technology only has a relatively low significance for current and future teaching. This discrepancy was studied in a differentiated manner in order to gear the further development and implementation of VR towards the target group. Methods: From January 2020 to July 2020, medical students (N=318) were asked to watch ten videos online and rate them on the basis of acceptance indicators (e.g., fun and fairness). Using obstetrics as an example, the videos demonstrated five levels of VR technology functionality (e.g., haptic and adaptive feedback), some of which were visionary, in two use scenarios (teaching and the OSCE). The individual and aggregate indicators were compared with non-parametric testing procedures across application scenarios, functional levels and genders. In addition, correlations between the acceptance and the factors of semester, age, computer affinity, and previous VR experience were analyzed. Results: Across all functional levels, VR was more likely to be accepted in the classroom than in the OSCE. Comparisons across functional levels also revealed that the VR ready to be marketed was significantly more accepted than the visionary functions. This skepticism toward advancing VR technology was most pronounced with regard to the vision of autonomous VR examinations and among female students with a low computer affinity. Conclusion: The results suggest that the students' reservations are due to a lack of experience with the VR technology. In order for young physicians to become familiar with the technology and to be able to use it competently in the everyday clinical practice in the future, VR should not only be used as a teaching tool but also be part of the curriculum. Practical examinations using VR, on the other hand, are only recommended once the technology has become established in teaching and has been proven to be reliable.

Project description:IntroductionIn behavioral health care settings, a workforce well trained in suicide prevention is critically important for behavioral health care professionals across different disciplines and service sectors who are likely to have considerable exposure to patients at risk for suicidal behavior. This study examined the types of training behavioral health care professionals received, their self-reported skills, comfort level and confidence related to suicide prevention, the association of types and length of training with skills, comfort level and confidence, and areas in which participants would like more training.MethodsThe Zero Suicide Workforce Survey was administered electronically to behavioral health care professionals at six behavioral health treatment centers with both inpatient and ambulatory programs in Connecticut, USA. Item numbers and percentages were calculated for 847 respondents with behavioral health care roles. The chi-square tests were performed to determine the statistical significance of group differences. Non-parametric sign tests were performed to determine the statistical significance of the collective differences in direction among items between groups.ResultsSuicide prevention training is associated with increased levels of behavioral health care professionals' skills and confidence, but one-third of behavioral health care professionals in the sample received no formal training in suicide prevention/intervention. Even brief training appears to have a positive impact on behavioral health care professionals' assessment of their skills and confidence. Prominent topics for additional training include suicide-specific treatment approaches, suicide prevention and awareness, and identification of risk factors and warning signs.ConclusionAlthough behavioral health care professionals may often encounter patients at risk for suicide, many have not obtained any relevant training. The findings highlight the need to strengthen suicide identification, assessment and treatment within behavioral health care treatment settings as part of an effort to prevent suicide.

Project description:Objective: Each year, more than 30,000 deaths occur on U.S. roads. Recognizing the magnitude and persistence of this public health problem, a number of U.S. cities have adopted a relatively new approach to prevention, termed Vision Zero (VZ). VZ has been adopted by more than 30 U.S. cities and calls for creating a transportation system that ensures that no road traffic crash results in death or serious injury. A core component of VZ is strong multidisciplinary and multisector stakeholder engagement, and cities adopting VZ often establish a VZ coalition to foster stakeholder collaboration. However, there is little information on the structure, development, and functioning of coalitions working to achieve VZ and on tools available to study and evaluate such coalition functioning. We sought to describe the characteristics of prominent U.S. VZ city coalitions and context surrounding VZ uptake and advancement in these cities. Moreover, we demonstrate use of network analysis as one tool for exploring the structure of interorganizational relationships in coalitions. Methods: We conducted case studies of 4 prominent U.S. VZ city coalitions in 2017-2018. We summarized coalition members' characteristics and responses to questions about their cities' VZ adoption, planning, and implementation. We asked each coalition member to provide information on their contact frequency, perceived productivity, and resource sharing with every other coalition member in their city and used network analysis techniques in 2 cities to understand the structures and relationships in coalitions. Results: Findings indicated that government agencies generally constituted the majority of coalition members and often played central roles in terms of coalition network contact, productivity, and resource flow. Other emerging similarities regarding coalition establishment and VZ implementation included the need for political support, the importance of formal plan development, and increased collaboration and cooperation among partners. Conclusions: Organizational network analyses, enriched with coalition member interviews, can elucidate key aspects of coalition creation, attributes, and relationship structure. The case studies of leading VZ coalition networks presented here highlight the use of these tools. Ultimately, understanding associations between VZ network structures and attributes and road safety outcomes could help inform effective coalition adoption, implementation, and maintenance to optimize safety outcomes.

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Skepticism towards the Swedish vision zero for suicide: interviews with 12 psychiatrists.

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Skepticism towards the Swedish vision zero for suicide: interviews with 12 psychiatrists.

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