(PS8-20) A Qualitative Examination of Iatrogenic Concerns Reported by Hospitalized Individuals Displaying Recent Suicidal Thoughts and Behaviors

Abstract Text: The treatment of individuals experiencing suicidal thoughts and behavior (STBs) is a complex undertaking which must accurately assess and take appropriate, evidence-based steps to manage risk (Jobes et al., 2008). While referral to an inpatient psychiatric setting is common practice for those deemed high risk for suicide (Chammas et al., 2022), suicide rates among both current and former (Franklin et al., 2017) psychiatric inpatients are significantly higher than in the general population. The period of time immediately following a person's discharge from the controlled environment of inpatient care, in which they return to an everyday life featuring both life stressors present before their hospitalization and those which may have arisen from disruptions to their life associated with being hospitalized, is one of particular vulnerability (Chung et al., 2019).

Iatrogenic concerns associated with inpatient hospitalization for suicide risk have also been voiced (Morrison et al., 1999). Large and colleagues (2013) argue that “nosocomial suicides” at least partially attributable to elements of inpatient care (i.e., life disruptions resulting from and/or negative experiences during hospitalization) directly contribute to observed spikes in suicide rates of individuals immediately following psychiatric discharge. Such concerns often subvert psychiatric inpatients' expectations for their care (Hopkins et al., 2009), which can limit protective benefits of treatments received and willingness to follow up with outpatient resources post-discharge. However, most research examining iatrogenic concerns in psychiatric hospitalization is completed following patients' discharge from care (e.g., Morrison et al., 1999) rather than during their engagement with services, leading Ward-Cieselski and Rizvi (2021) to call to establish a substantial base of research examining patient experiences of inpatient treatment for suicide-related concerns.

The current project has undertaken a qualitative evaluation of responses from over 1,200 interviews with psychiatric inpatients presenting with suicide-related concerns at one of three psychiatric inpatient facilities. Project interviews were conducted using the Suicide Status Form-4 (SSF-4) – a semi-structured clinical interview that captures both quantitative and qualitative information regarding respondents' history with suicide and sources of present distress (e.g., painful emotions, drivers for suicide) – in the context of the single-session Collaborative Assessment and Management of Suicidality – Brief Intervention (CAMS-BI; Oakey-Frost et al., 2024) protocol. Interviews were conducted and recorded by trained psychology externs completing their doctorates in clinical psychology at a university in the American Southeast. Using thematic analysis, the project team will identify and define themes of iatrogenic concerns volunteered by participants during their CAMS-BI session. In doing so, study findings can inform efforts to improve patients' experiences in inpatient treatment for suicide-related concerns and add to a needed line of research regarding potential iatrogenic concerns experienced by patients hospitalized for STBs (Ward-Cieselski and Rizvi, 2021).