Development and evaluation of an educational module and workshop for pharmacists managing suicidal ideation

Stover A.N., Lavigne J.E., Carpenter D.M.

Objective. This scoping review updates a 2018 review of suicide prevention (SP) training programs for community and student pharmacists. Five scholarly databases were searched for articles published between January 2018 and December 2020. Articles were excluded if they: 1) did not describe an educational or training program for pharmacists or student pharmacists; 2) did not explicitly include suicide; 3) focused solely on attitudes; or 4) did not provide sufficient detail to evaluate program content. The quality of each study was examined using a quality assessment tool. Findings. Seven studies met inclusion criteria. Most trainings (86%) were delivered live with interactive, or role play scenarios to promote verbal and behavioral skill practice. About half (57%) assessed changes in knowledge and fewer programs (29%) assessed changes in communication. All assessed the ability to identify suicide warning signs and included referral resources. Six studies were assessed for quality; 67% had a rating of good, and 33% were rated as fair. Summary. Given the increase in suicide rates nationally, it is likely that pharmacists will encounter a patient in need of suicide prevention services. Since 2018, seven new SP training programs for community and student pharmacists have been reported, which demonstrates growing interest in SP training in the pharmacy profession. When integrated in PharmD curricula, trainings may help prepare the pharmacy workforce for encounters with patients in crisis. The impact of training on self-efficacy and communication skills warrants additional attention. Variation between programs should be evaluated to understand which instructional methods best prepare pharmacy professionals to engage in suicide prevention.

Gorton H.C., Berry H.J., O'Reilly C.L., Gardner D., Murphy A.L.

Community pharmacists are increasingly recognized as integral members in suicide prevention programs, as part of a multidisciplinary and multifaceted approach. However, further research is required to understand then optimize the whole pharmacy teams' role across sectors.To explore pharmacy teams' experience of, and attitudes towards, suicide prevention in England.A cross-sectional survey was purposively distributed to pharmacy staff in England before accessing an optional suicide awareness raising video, hosted by Centre for Pharmacy Postgraduate Education (CPPE), in September 2019-March 2021. Questions included demographics and experience of, attitudes towards, and preparedness for, suicide prevention. The 14-item Attitudes to Suicide Prevention (ASP) scale was used (possible range 14-70 with lower scores representing positive attitudes). Descriptive and comparative statistics were reported. Free-text comments were invited to explore respondents' experience of suicide prevention and reflexive thematic analysis used.Of 403 respondents, 82% were female; most were pharmacists (59%) or pharmacy technicians (21%), with the remainder having other roles. Eighty-five percent worked in community pharmacy. Eleven percent had prior suicide prevention training, and 71% reported interacting with at least one patient about suicide. Most often, suicidality was disclosed by the patient (40%), with 6% of pharmacy staff having directly asked a patient about suicidal behavior or plans. The aggregated ASP score was 31.51 (SD 6.23), and role did not affect experience or attitude. Pharmacy teams' experiences of suicide prevention can be summarized by three major themes i) Exposure to suicide; ii) Responsibility for action; and iii) Access to means of suicide.Pharmacy teams felt responsibility in caring for those at risk of suicide and had experience of this. Further training should include understanding of medicines means restriction and involve all roles and sectors of pharmacy. Pharmacy teams should be integrated into the 'circle of care' to access referral pathways.

El-Den S., Choong H., Moles R.J., Murphy A., Gardner D., Rosen A., O’Reilly C.L.

Abstract Background There is a need to appropriately train, support and remunerate pharmacists for their expanding roles in mental healthcare. Pharmacists often care for people experiencing mental health crises, including suicidal thoughts and behaviours, but little is known about pharmacists’ suicide care experiences. Aim This cross-sectional study aimed to explore the impact of professional experiences with people at risk of suicide and support accessed, among community pharmacists. Method A survey exploring pharmacists’ experiences with people at risk of suicide and post-intervention support-seeking was disseminated through Australian and Canadian professional associations, conferences and social media (June 2016-May 2017). Quantitative data were analysed using Chi-squared, Fisher’s exact and independent t-tests, where appropriate. Qualitative data exploring the impact of these experiences were thematically analysed, and reasons for not seeking help post-intervention were identified. Results Among 378 respondents, 84% had encountered patients at risk of suicide and 28% had lost patients to suicide. Some were negatively affected personally and/or professionally (11%), of which 88% did not seek professional support, mainly due to uncertainty about available services. Pharmacists were significantly more negatively affected if they had a personal mental health diagnosis (p = 0.017) and previous suicide care experiences (p = 0.001). Qualitative themes included: expanding knowledge and skills, role limitation and emotional impact and response. Conclusion A large proportion of pharmacists have interacted with suicidal patients and are impacted by these experiences, yet few seek help due to lack of awareness and access. There is a need to recognize pharmacists’ roles in suicide care, and develop pharmacist-specific post-intervention support.

Carpenter D.M., Lavigne J.E., Colmenares E.W., Falbo K., Mosley S.L.

Background Little is known about community pharmacy staff members’ interactions with patients at risk of suicide. Objectives To: 1) develop a measure to assess the frequency with which pharmacy staff encounter patients with suicide risk factors and warning signs; 2) to assess the measure's validity and reliability; and 3) describe pharmacy staff members' interactions with at-risk patients and their suicide prevention training preferences. Methods A convenience sample of 501 community pharmacy staff members who worked in North Carolina completed an anonymous online survey. A 10-item measure (the Pharmacy Suicide Interaction Scale (PSIS)) assessed how often respondents encountered patients with suicide risk factors or warning signs, and one open-ended question elicited barriers to interacting with these patients. Psychometric analyses, including an exploratory factor analysis, were performed to examine the validity and reliability of the PSIS. Descriptive statistics were calculated, and responses to open-ended questions were analyzed thematically. Results The PSIS possessed two factors (or subscales): a non-verbal suicide warning signs and risk factors subscale (Cronbach's alpha = 0.79) and a verbal warning signs subscale (Cronbach's alpha = 0.67). Respondents who knew a patient who had died by suicide had higher mean scores on the non-verbal and verbal subscales, indicating that the PSIS had construct validity. Many respondents (22.4%) knew a patient who died by suicide, and 21.6% of respondents had patients request a lethal dose of medication. Interactions occurred both face-to-face and over the phone, and respondents most commonly reacted to patients by contacting others or offering emotional support. Few respondents (8.8%) had suicide prevention training or resources, but most (89.6%) desired additional training. Conclusion Many community pharmacy staff members have interacted with patients who exhibited suicide warning signs or died by suicide. Suicide prevention training may help prepare pharmacy staff to recognize, communicate with, and refer at-risk patients.

Willson M.N., Robinson J.D., McKeirnan K.C., Akers J.M., Buchman C.R.

Boukouvalas E., El-Den S., Murphy A.L., Salvador-Carulla L., O’Reilly C.L.

Health care professionals are paramount to the prevention and management of suicidal thoughts and behaviors. Confidence in caring for people at risk of suicidal thoughts and behaviors is influenced by knowledge of and attitudes towards suicide. This systematic review aimed to explore health care professionals' knowledge of and attitudes towards suicide, as well as, their confidence in caring for people at risk of suicidal thoughts and behaviors. A systematic search of 4 electronic databases over 10 years was conducted. Following retrieval of 1,723 abstracts, 46 primary research publications were included, involving both cross-sectional (n = 27) and intervention study designs (n = 19). Knowledge of, attitudes towards, and confidence in caring for people at risk of suicidal thoughts and behaviors were explored among primary health care professionals, specialists, and health care students. The influence of training and education, type of health care professional, country of practice, and prior experience with suicide were highlighted among included studies. Health care professionals' knowledge of, attitudes towards and confidence in caring for people at risk of suicide are complex, interrelated constructs that shape their behaviors and may impact patient outcomes. Suicide training and education is necessary within health care curricula and as part of health care professionals' continuing professional development.

Painter N.A., Kuo G.M., Collins S.P., Palomino Y.L., Lee K.C.

Suicide in the United States is a major preventable public health problem. Pharmacists need to be educated on suicide prevention strategies so that they can increase their own awareness and identify patients at-risk. A training program for pharmacists was used to provide skills necessary to recognize a crisis and the warning signs of suicide. The program's effect on the participant's general perception, self-efficacy, and attitude towards suicide prevention was examined.Various academic, health care, and professional meetings throughout San Diego County.First Question, Persuade, and Refer training program targeting pharmacists.A self-administered presurvey, postsurvey and, Program Outcome Evaluation were given to participants of the suicide training program. Items included demographics, general perception, self-efficacy, and attitude toward suicide prevention. Descriptive statistics were used to describe participants' demographics. t tests were used to compare general perception, attitudes, and self-efficacy scores between pretest and post-program evaluation survey responses. Nonparametric Wilcoxon signed rank analyses for matched pairs were used to compare survey responses that asked about attitudes before and after trainings. Regression analyses were conducted to assess factors associated with general perception, self-efficacy, and attitudes.Participants were more likely to update knowledge after training and reported more confidence to make an intervention for a patient at risk for suicide.Our findings suggest that a suicide prevention training program helped pharmacist respondents build confidence in several self-efficacy areas relating to detection of suicide signs, response to patients with suicidal thoughts, reassurance for patients, and provision of resources and referrals.

Berlim M.T., Perizzolo J., Lejderman F., Fleck M.P., Joiner T.E.

To evaluate a brief training program on suicide prevention for front-line general hospital personnel in terms of its impact on their attitudes and beliefs towards suicidality.Forty non-clinical (e.g., security staff), and 102 clinical (e.g., nursing attendants) professionals employed in a university hospital in Brazil were evaluated with the Suicide Behavior Attitude Questionnaire [SBAQ] before the start and immediately after a 3-hour training on suicide prevention.Surprisingly, there were no significant differences for the great majority of the SBAQ items (i.e., 20 of 21) between clinical and non-clinical staff both pre- and post-training. Furthermore, their attitudes and beliefs towards suicidality were significantly improved after training in the majority of SBAQ items, with p-values ranging from 0.01 to

Herron J., Ticehurst H., Appleby L., Perry A., Cordingley L.

A questionnaire assessing attitudes toward suicide prevention was constructed and shown to have satisfactory reliability and internal consistency. The determinants and distribution of these attitudes were investigated in four groups of health professionals who are in contact with suicidal patients: general practitioners, accident and emergency nurses, psychiatrists in training, and community psychiatric nurses. Attitudes toward suicide prevention were shown to differ significantly between professional groups. More positive attitudes were associated with mental health professionals, working in the community, and previous training in suicide risk assessment. Negative attitudes should be assessed and targeted in training designed to improve the management of suicide risk.