Suicide is currently one of the leading causes of death in the U.S. and has been shown to have lasting negative effects on individuals, families, and communities. For this project, we sought to identify barriers that clinicians face when implementing suicide prevention practices in order to help enhance implementation efforts in the future. We conducted a secondary qualitative analysis of interviews with 26 clinicians from different health-care settings to better understand their emotional reactions to this work. Figure 1 illustrates how clinician anxiety can be a barrier to suicide prevention practices through the cycle of avoidance model — when a client presents with risk for suicide, clinician anxiety is raised, which may lead to an avoidance behavior such as not fully screening or asking leading questions. This results in the clinician feeling relief, which in turn reinforces the avoidance behavior.

To conduct this secondary analysis, we coded the interview transcripts for clinician emotional reactions, anxiety, or distress around suicide screening, assessment, and safety planning. Our one code also included any references to uncertainty around the same procedures as well as any mentions of relief when patients present with lower risk. This helped us to identify common barriers to suicide prevention implementation in different settings, which will inform the future development of training that can target these barriers specifically. All the transcripts were double coded and any disagreement was resolved, and we achieved strong reliability with consensus. Our results pinpointed multiple different ways in which clinicians experience emotional reactions and how it in turn influences their practices. These quotes are examples pulled from the transcripts. While the reasons for worry vary across clinicians and different health-care settings, some common ones centered around confidence with clinical decision making, follow up after a client leaves, and the consulting availability of other clinicians in the office. Our formal analysis is still in progress as we work to identify the most prominent themes within this clinician anxiety, although our findings support ongoing work at Penn. This summer, I also worked on Project CALMER, which focused on directly targeting this clinician anxiety through newly-developed trainings that utilize an exposure-based implementation strategy. Our work from this project will inform the continuing development of the CALMER trainings.