Attitudes of health professionals towards suicidal behavior: an intervention study

Faria, Jesiele Spindler; Marcon, Samira Reschetti; Nespollo, Alice Milani; Santos, Hugo Gedeon Barros dos; Espinosa, Mariano Martínez; Oliveira, Kleici Kleslly Brito de; Lima, Josemara Gomes da Silva

doi:10.11606/s1518-8787.2022056003320

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Original Article • Rev. Saúde Pública 56 • 2022 • https://doi.org/10.11606/s1518-8787.2022056003320 copy

Attitudes of health professionals towards suicidal behavior: an intervention study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To evaluate the effect of an educational intervention on the attitudes of primary healthcare providers regarding patients with suicidal behavior.

METHODS

Clinical trial randomized by clusters, with a sample of 261 healthcare professionals, from 22 health units selected by stratified sampling, were chosen and randomly allocated, by drawing, into two groups: intervention (n = 87) and control (n = 174). The participants of the intervention group were exposed to a 20-hour training on suicidal behavior. All 261 participants were evaluated before and after the intervention; the groups were compared to evaluate their attitude towards suicidal behavior using the Suicide Behavior Attitude Questionnaire (SBAQ), an evaluation made by comparison of the means via t-Student test, for independent samples, and paired t-test, for dependent samples.

RESULTS

The intervention group, in comparison to their evaluation before and after training, as well as in the comparison with the evaluation of the control group, showed statistically significant differences in attitudes towards suicidal behavior, according to the differences presented in the scores for the domains: “perception of professional capacity,” in all four items; “negative feeling,” in six of the seven items; and in the “right to commit suicide” domain, in three of the five items.

CONCLUSION

The brief training developed in primary health care was effective to improve the attitudes of the participants who were part of the intervention group regarding patients with suicidal behavior.

Attitude of Health Personnel; Health Human Resource Training; Suicidal Ideation; Primary Health Care; Randomized Controlled Trial

Stratum	Number of FHS teams	Total number of Professionals	%	Professionals by team	Number of teams selected	Professionals selected by region
Northern Region	24	115	38.59	4	8	26
Southern Region	21	86	27.85	4	7	19
Eastern Region	11	51	17.11	4	4	12
Western Region	11	49	16.44	4	4	11
Total	67	298	100	4	22	68

Characteristics	Intervention Group	Control group	n (88)	(%)
Characteristics	n (69)	(%)	n (88)	(%)
Age group
20–39	31	44.9	31	35.2
40–59	37	53.6	49	55.7
60–79	1	1.4	8	9.1
Gender
Woman	60	87.0	79	89.8
Man	9	13.0	9	10.2
Education Level
Without higher education	11	15.9	15	17.0
With higher education	58	84.1	73	83.0
Marital status
With a partner (married, stable union)	36	52.2	57	64.8
Without a partner (single, separated, widower)	33	47.8	31	35.2
Religion
Yes	58	84.1	79	89.8
No	11	15.9	9	10.2
Occupation
Physician	17	24.6	25	28.4
Nurse	18	26.1	24	27.3
Nursing technician	34	49.3	39	44.3
Mental health training
Yes	27	39.1	25	28.4
No	42	60.9	63	71.6
Suicide training
Yes	8	11.6	22	25.0
No	61	88.4	66	75.0
Attended suicidal ideation
Yes	51	73.9	43	48.9
No	18	26.1	45	51.1
Attended suicide attempts
Yes	37	53.6	45	51.1
No	32	46.4	43	48.9
Attended patients who have committed suicide
Yes	18	26.1	20	22.7
No	51	73.9	68	77.3
Have you ever thought of committing suicide
Yes	11	15.9	11	12.5
No	58	84.1	77	87.5
Have you ever attempted suicide
Yes	2	2.9	9	10.2
No	67	97.1	79	89.8
In your family has anyone attempted suicide
Yes	27	39.1	20	22.7
No	42	60.9	68	77.3
In your family has anyone committed suicide
Yes	12	17.4	9	10.2
No	57	82.6	79	89.8
Among your friends, has anyone attempted suicide
Yes	27	39.1	21	23.9
No	42	60.9	67	76.1
Among your friends, has anyone committed suicide
Yes	23	33.3	23	26.1
No	46	66.7	65	73.9

Factors	Intervention Group pre-test^a	Control group pre-test^b	p-value^c	Intervention Group post-test^d	Control group post-test^e	p-value^f
Factor 1. Feelings towards the patient
Those that keep threating to kill themselves usually do not go through with it.	3.70	4.55	0.020	0.10	4.35	< 0.01
Deep down, I would rather not get too involved with patients who attempted suicide.	1.00	2.85	0.132	0.10	2.00	< 0.01
I am afraid to ask about suicide ideas and end up inducing the patient into it.	1.70	3.00	0.337	1.00	2.55	< 0.01
Deep down, sometimes it is even infuriating, because there is so many people who want to live and that patient wants to die.	1.70	3.50	0.015	0.40	3.80	< 0.001
One feels powerless in front of a person who wants to kill themselves.	5.20	5.70	0.524	2.20	5.30	< 0.001
In the case of patients who are suffering greatly from a physical illness, I find the idea of suicide more acceptable.	1.40	2.70	< 0.01	0.60	2.80	< 0.01
If you really want to kill yourself, you do not keep trying to kill yourself.	1.80	1.85	0.376	0.10	2.00	< 0.01
Factor 2. Perception of professional capacity
I feel like I can help someone who attempted suicide.	5.30	5.35	0.914	8.25	5.85	< 0.01
I feel I am capable to recognize when a patient is at risk of committing suicide.	4.61	4.31	0.479	8.65	3.70	< 0.01
I think I have professional preparation to deal with patients at risk of suicide.	2.50	3.10	0.602	7.50	3.00	< 0.01
I feel insecure to attend patients at risk of suicide.	5.60	6.15	0.614	3.00	6.45	< 0.01
Factor 3. Right to suicide
After all, I think a person has the right to commit suicide.	0.60	1.00	0.618	1.50	1.00	0.131
In the face of a suicide, I think: if someone had talked, the person would have found another way.	8.20	8.10	0.934	9.50	8.00	< 0.01
Life is a gift from God and only He can take away.	9.50	10.00	0.009	8.00	9.50	0.001
Whoever has God in their heart will not try to kill themselves.	4.60	5.30	0.442	1.60	5.15	0.025
When a person talks about ending their life, I try to get that out of their head.	8.90	8.35	0.132	9.00	8.80	0.597

Factors	Intervention Group pre-test^a	Group intervention post-test^b	Z^c	p^d
Factor 1. Feelings towards the patient
Those that keep threating to kill themselves usually do not.	3.56	1.12	-5.763	< 0.01
Deep down, I’d rather not get too involved with patients who attempted suicide.	2.13	0.96	-2.778	0.005
I am afraid to ask about suicide ideas and end up inducing the patient into it.	2.90	1.08	-4.244	< 0.01
Deep down, sometimes it is even infuriating, because there is so many people who want to live and that patient wants to die.	3.39	1.26	-4.787	< 0.01
One feels powerless in front of a person who wants to kill themselves.	5.29	3.06	-4.540	< 0.01
In the case of patients who are suffering greatly from a physical illness, I find the idea of suicide more acceptable.	2.71	2.02	-1.814	0.070
If you really want to kill yourself, you do not keep trying to kill yourself.	3.12	0.96	-5.462	< 0.01
Factor 2. Perception of professional capacity
I feel like I can help someone who attempted suicide.	5.38	8.28	-6.323	< 0.01
I feel I am capable to recognize when a patient is at risk of committing suicide.	4.61	7.78	-6.138	< 0.01
I think I have professional preparation to deal with patients at risk of suicide.	3.53	6.81	-5.606	< 0.01
I feel insecure to attend patients at risk of suicide.	5.70	3.55	-4.206	< 0.01
Factor 3. Right to suicide
After all, I think a person has the right to commit suicide.	1.90	2.58	-1.719	0.086
In the face of a suicide, I think: if someone had talked, the person would have found another way.	10.0	7.93	-3.580	< 0.01
Life is a gift from God, and only He can take away.	8.74	7.04	-4.399	< 0.01
Whoever has God in their heart will not try to kill themselves.	4.50	3.25	-3.278	0.001
When a person talks about ending their life, I try to get that out of their head.	8.27	9.46	-1.189	0.234

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E-mail: revsp@usp.br

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[1] Correspondence: Jesiele Spindler Faria Av. Fernando Correa da Costa, 2.367 Boa Esperança 78060-900 Cuiabá, MT, Brasil E-mail: profjesiele@gmail.com