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Article

Health Workers’ Perceptions of Suicide Risk Assessments: A Survey Study from Norway

1
Division of Substance Use and Mental Health, University Hospital of North Norway, 9019 Tromsø, Norway
2
Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Kjonerud Kompetansesenter, 2312 Ottestad, Norway
3
Faculty of Social and Health Sciences, University of Inland Norway, 2418 Elverum, Norway
4
Department of Health and Care Sciences, UiT The Arctic University of Norway, 9019 Tromsø, Norway
5
Department of Clinical Medicine, UiT The Arctic University of Norway, 9019 Tromsø, Norway
6
Clinical Medicine Department, Universidad Miguel Hernández, 03550 Alicante, Spain
*
Author to whom correspondence should be addressed.
Psychiatry Int. 2026, 7(2), 56; https://doi.org/10.3390/psychiatryint7020056
Submission received: 4 November 2025 / Revised: 12 December 2025 / Accepted: 25 February 2026 / Published: 5 March 2026

Abstract

Suicide is a serious and global health problem, with important consequences for individuals and for society. Understanding health workers’ perspectives is important for understanding how clinicians think about this topic and their attitudes toward and adherence to current guidelines. These findings can also have implications for future directions in guideline development and suicide-prevention policy. The purpose of this study was to investigate health workers’ experiences with and perceptions of suicide risk assessments. We conducted an electronic survey in which we asked health workers (N = 183) 18 questions about their experiences with and opinions about suicide risk assessments, suicide prevention, risk factors for suicide, and questions relating to the Norwegian guidelines for suicide risk assessment. The health workers in this study consisted of psychologists, doctors, nurses, and social workers from three different Norwegian hospitals. We found that the professional groups differed significantly in their responses. We also found significant differences between staff at the different hospitals in how they perceived the risk factors and standardized questions. In general, the respondents were skeptical regarding the emphasis on standardized suicide risk assessments. Furthermore, respondents perceived suicide as at least partly preventable. There were some differences between professions and hospitals. This may be due to cultural and educational aspects. Suicide risk prevention is complex, involving a variety of factors. Methodological limitations should be taken into consideration. Future research should further explore health workers’ concerns about standardized suicide risk assessments.

1. Introduction

Suicide is a widespread and serious public health problem, with important consequences for individuals, families, and society. According to the World Health Organization, more than 700,000 people die by suicide every year globally [1]. The mental health care services play a central role in preventing suicide [2]. In Norway, in the period 1970 to 1990, the risk of suicide doubled and then fell again. The increase was most dramatic for young men in the age group 15–24 years. In 2023, the suicide rate was 12.9 per 100,000 inhabitants, 21 percent lower than in 1990. There has been a slight but significant increase in age-standardized suicide rates between 2010 and 2019 [3]. Suicide methods have changed over time. Among men, hanging and suffocation are the most common methods, and poisoning is among women [3,4]. The prevalence of suicide is fairly similar in Norway, Sweden, and Denmark (around 11 per 100,000), but Finland still has a significantly higher prevalence than the other Nordic countries (almost 20 per 100,000). The incidence of suicide in Norway is somewhat higher than in Europe. Deaths by suicide in the EU have decreased by 13% in a decade [5]. Cultural factors may also play a role in suicide rates, and the indigenous Sami population has had a higher suicide rate than the rest of the Norwegian population, possibly linked to the Sami people’s struggle to preserve their culture, loss of identity, and a social contagion effect [6].
There is an ongoing debate about the health workers’ role and the utility of suicide screening (brief procedures to identify who might be at risk), suicide risk assessment (more in-depth assessments of the nature and severity of risk), and suicide prevention [7,8]. According to current recommendations and guidelines, health workers should implement screening procedures involving standardized tools in order to map their patients’ risk of suicide [9]. A standardized procedure for suicide risk assessment would also involve a standardized tool and include elements such as taking the patient’s prior medical history, assessing the patient’s current mental status, and focusing on risk factors, including prior attempts and substance abuse [10,11].
There are some guidelines that recommend suicide risk assessments, including those from the National Institute for Health and Care Excellence (NICE) [12], the European Psychiatric Association (EPA) [13], the American Psychiatric Association (APA) [14], and the Norwegian Directorate of Health [15]. The NICE guidelines and the EPA guidelines recommend performing suicide risk assessments with caution and emphasize that it is difficult to predict suicides [12,13]. The guidelines from the APA suggest that the goal of the suicide risk assessment is to estimate an overall level of suicide risk [14]. The aim of the Norwegian guidelines has been to prevent suicides through standardized and frequent suicide risk assessments by mental health practitioners [15].
The target for the EPA is to halve the number of suicides in the next 5 years by preventing, detecting early, and treating completely psychiatric disorders—depression in particular [16]. The APA recommends early contacts with providers, effective mental health care, easy access to a variety of clinical interventions, connections to individuals, family, community, and social institutions, and a strong sense of cultural identity [17]. The NICE guidelines present five quality statements covering multi-agency suicide prevention partnerships to reduce access to methods of suicide, a local media plan that identifies how they will encourage journalists and editors to follow best practices, involving family, carers, or friends, and bereaved or affected individuals are given information and offered tailored support [18].
Some have been critical of the ‘one size fits all’ approach that they believe such guidelines represent [19]. One point that is made is that the guidelines recommend standardized suicide risk assessments that are excessively biomedically oriented and that do not sufficiently take contextual, psychosocial, and individual factors into consideration [20]. Some propose a fundamentally different approach and suggest dropping standardized risk assessment procedures altogether and instead highlighting genuine and empathetic listening, the expression of compassion, and embedding the exploration of risk factors and protective factors in the interaction [21].
Cohen et al. [22] surveyed 90 health workers and found that few relied on standardized risk measures. They also found that the health workers did not know how to improve suicide risk assessment. A recent review found that doctors who believe that suicide can be prevented more frequently perform screenings and thorough risk assessments [23].
According to a study by Espeland et al. [7], health workers thought that the emphasis on standardized suicide risk assessment compromised other aspects of suicide prevention, including the therapeutic relationship. A Swedish study found that social workers emphasized relationships, past experiences, and professional discretion when working with suicidal clients [24]. Similarly, a Canadian phenomenological study involving psychologists found that the clinicians emphasized the importance of clinical intuition in this context [25].
Thus, it can be difficult to predict suicide, and this uncertainty can be a challenge for health workers. Previous research suggests that working with suicidal patients can be anxiety-provoking [25,26].
Understanding health workers’ perspectives is important for understanding how clinicians think about this topic and their attitudes toward and adherence to current guidelines. These findings can also have implications for future directions in guideline development and suicide-prevention policy. Still, very few studies have investigated health workers’ opinions of suicide risk assessments. Prior research on factors of general importance to attitudes of clinicians in mental health care has suggested that gender, profession, experience, and workplace are factors that can be relevant [27,28], but there is a gap in the literature that addresses these factors with respect to attitudes toward suicide risk assessment in Norway. The aim of the present study is to investigate the health workers’ perceptions and attitudes toward suicide risk assessments.

2. Materials and Methods

2.1. Study Design

This is an exploratory and descriptive study, which implies that the findings should not be interpreted causally.
A questionnaire survey was administered through Questback (Questback, Oslo, Norway), an online survey system. All responses were completely anonymous. No IP addresses or any other identifying information were registered. The survey was configured in Questback so that each item required a response before the questionnaire could be submitted. As a result, the dataset contains no missing values. The questionnaire was initiated by opening an electronic link from an email that was distributed to employees at three hospitals located in Norway (University Hospital of North Norway, Helgeland Hospital, and Innlandet Hospital Trust). These hospitals were chosen because they are located in different geographical areas of Norway and belong to separate health trust organizations, which might increase the chance of identifying variations in attitudes to suicide risk assessment. We do not know the exact number of people who received the email, which means that the response rate cannot be calculated. According to Norwegian regulations, surveys such as the present one, which are based on anonymous data, do not require approval from the Regional Committees for Medical and Health Research Ethics [29]. The study was assessed by and received approval from a Data Protection Officer (Personvernombud).
The questionnaire was developed by the research team based on national guidelines, previous qualitative studies, and risk-assessment literature. It is not a standardized or validated instrument. The respondents were instructed to report their points of view on a five-point Likert scale, with options ‘strongly disagree’, ‘disagree’, ‘undecided’, ‘agree’, or ‘strongly agree’. There were 18 questions about suicide risk assessments, suicide prevention, and risk factors. The complete questionnaire can be found in Appendix A.

2.2. Recruitment and Participants

A total of 183 (60 men, 123 women) health workers responded (Table 1). There were 110 respondents in the age group 20–50 years, whereas 73 were in the age group 50–70 years. The respondents consisted of 45 doctors, 68 psychologists, 33 nurses, and 37 social workers. They were working at either the University Hospital of North Norway (N = 61), Helgeland Hospital (N = 28), or Innlandet Hospital Trust (N = 94). Almost half of the respondents had less than 15 years of clinical experience.

2.3. Statistical Analysis

Data were analyzed with IBM SPSS version 24 (IBM, Armonk, NY, USA). We conducted a Shapiro–Wilk test for all 18 questionnaire items and the demographic variables included in the analyses. All variables showed a significant deviation from normality (p < 0.05). Based on these findings, we conducted non-parametric tests (Kruskal–Wallis and Friedman tests) for group comparisons. Consequently, we applied non-parametric tests (Kruskal–Wallis and Friedman tests) to analyze differences between hospitals, genders, professions, experience, and age. In addition, we analyzed data with descriptive statistics. The Section 3 only displays the significant results from the non-parametric tests.

3. Results

Table 2 displays the mean scores and median scores of the responses to all 18 questions. Analyses of age group and years of clinical experience showed no significant differences on any of the questionnaire items and are therefore not reported in detail. The highest agreement with the questionnaire statements was found for the item ‘It is important to identify risk factors for suicide (e.g., prior attempts and substance abuse)’, with a mean score of 3.78, followed by the item ‘Most suicides can be prevented’, which had a mean score of 3.71. There was also very high overall agreement with the statements ‘There is no certain way to find out who will commit suicide’ (mean score 3.63), ‘Even if you know who will commit suicide, it is impossible to know when it will occur’ (mean score 3.62), and ‘National guidelines for suicide prevention in mental health care have received criticism for relying too heavily on suicide risk assessments. This critique is warranted.’ (mean score 3.40).
The respondents were most critical of the following statements: ‘Talking with patients about suicide ideation can increase the risk of suicide’ (mean score 1.24) and ‘For suicide risk assessment, it is sufficient to ask the patient about suicide thoughts or plans’ (mean score 1.66).
The Friedman test revealed that the questions about national guidelines, utility of risk factors, and prevention of suicide had significantly higher scores than the other questions, X2 (17) = 890.0, p = 0.001. A pairwise comparison with adjusted p-values found that the item regarding national guidelines (item 14, Table 2) was significantly higher than the item regarding the utility of risk factors (item 4, Table 2) (p = 0.02, r = 0.020) and the item regarding the prevention of suicide (item 3, Table 2) (p = 0.017, r = 0.018).
Table 3 highlights the differences in responses between the participants of different professions with respect to their opinions about the Norwegian guidelines. To the item ‘The national guidelines for suicide prevention in mental health care have received criticism for relying too heavily on suicide risk assessments. This critique is warranted.’ (Item 14, Table 2), doctors were most in agreement (mean score 3.67), followed by psychologists (mean score 3.57), nurses (mean score 3.15), and social workers (mean score 2.97). The Kruskal–Wallis test revealed a significant difference between the different professions on this question regarding their perception of the Norwegian guidelines (H (3) = 29.48, p = 0.001). A pairwise comparison with adjusted p-values showed a significant difference between social workers and psychologists (p = 0.001, r = 0.46) and between social workers and doctors (p = 0.001, r = 0.49).
Table 4 demonstrates the relationship between the respondents’ workplace and how they perceived the Norwegian guidelines on suicide prevention. Respondents from the University Hospital of North Norway were most critical (mean score 3.54), followed by respondents from Innlandet Hospital Trust (mean score 3.44) and Helgeland Hospital (mean score 2.96). The Kruskal–Wallis test showed a significant difference between perception of the Norwegian guidelines at the different hospitals (H (2) = 18.14, p = 0.001). A pairwise comparison with adjusted p-values showed a significant difference between Helgeland Hospital and Innlandet Hospital Trust (p = 0.001, r = 0.33) and between University Hospital of North-Norway and Helgeland Hospital (p = 0.001, r = 0.43).
Table 5 highlights differences in perceptions regarding risk factors for suicide at different hospitals, with respondents at Innlandet Hospital Trust most in agreement (mean score 3.82) with the idea that it is important to identify risk factors, followed by respondents working at the University Hospital of North Norway (mean score 3.79), and lastly those working at Helgeland Hospital (mean score 3.63). These differences were statistically significant (H (2) = 8.28, p = 0.016).
Table 6 shows how respondents at the different workplaces perceived standardized questions. Those working at Innlandet Hospital Trust were most negative (mean score 3.17), followed by respondents from the University Hospital of North Norway (mean score 2.91) and Helgeland Hospital (mean score 2.63). The differences were statistically significant (H (2) = 7.93, p = 0.019).

4. Discussion

The aim of the present survey was to investigate health workers’ perceptions of suicide risk assessments. We found that health workers in general perceived the criticism of the Norwegian guidelines (from 2008) for suicide prevention as warranted (i.e., these guidelines rely too heavily on standardized suicide risk assessments). This is in agreement with previous studies [7,22]. However, it should be noted that the guidelines have very recently been updated [30] and that the most recent version, to a larger extent, emphasizes the importance of treatment and prevention. It is still emphasized that clinicians should assess suicide risk but do so in the context of treatment and individual needs [30].
Our respondents generally viewed suicide as partly preventable and considered risk factors clinically meaningful, which is in line with previous research [31]. There seems to be an agreement that suicide can be prevented and that risk factors are relevant. However, the clinical utility of risk factors and prevention at an individual level is debated [32].
In our study, the respondents working at Innlandet Hospital Trust were significantly less skeptical of the Norwegian guidelines compared to the respondents at the other hospitals. Psychologists and doctors were also significantly more skeptical of the guidelines than other professions. In addition, we also found that there were significant differences between hospitals regarding the utility of detecting risk factors and that standardized questions can affect listening skills.
These significant differences can be attributed to several likely explanations. First, there may be cultural differences between hospitals and also between professions. Such cultural differences between hospitals and professions have also been identified in other domains, for instance, regarding attitudes toward coercion [27]. The professional environment may affect health workers’ attitudes toward suicide risk assessments. This could be due to ‘social proof’ [33], i.e., that health workers tend to use other health workers as a reference for their behavior and attitudes. For instance, if a majority of the health workers perceive standardized suicide risk assessment as useful, this may affect their colleagues in the same direction.
Second, there may be differences in training, and psychologists and doctors rely more on the therapeutic relationship with the patient and are less focused on standardized procedures. Psychologists and doctors may rely more on their ‘clinical intuition’. Several studies have found that psychologists emphasized clinical intuition when working with suicide assessments [25,34].
Some health workers seem to perceive standardized suicide risk assessments as too mechanical and may underestimate the patients’ individual needs. In addition, some health workers view standardized suicide risk assessment as a form of self-protection, i.e., allowing the clinician to ‘hide behind’ or reduce their own anxiety about making mistakes by relying on standardized procedures [34]. Consequently, the critics of standardized suicide risk assessments recommend a ‘relational approach’ to suicide prevention [7]. Within the context of a psychiatric setting, a relational approach may rely on psychodynamic psychotherapy, focusing on experience, meaning, context, and issues such as attachment patterns, relational difficulties, and transference [35,36].
According to recommendations from NICE [12], a suicide risk assessment should not be used to predict future suicide or to determine the need for treatment or who should be discharged. Rather, it is recommended to use the assessment to focus on the patient’s needs and identify how to assist their psychological and physiological safety [12].
Current evidence suggests that suicide prevention and suicide risk assessment are highly complex tasks, involving a variety of quantitative and qualitative factors [37]. This complexity must be considered when attempting to prevent and assess suicide risk. The optimal suicide risk assessment strategy is still uncertain [38].

4.1. Future Perspectives, Practice, and Policy Implications

The new guidelines that have been developed in Norway should be carefully evaluated to study whether they improve the detection rate and possible prevention of suicides. Clinicians and leadership should place more emphasis on giving appropriate treatment and less on avoiding criticism from the authorities.
Future studies should investigate each profession with a larger sample and further explore health workers’ concerns about standardized suicide risk assessments, drawing on different methodologies. It would also be interesting to investigate alternatives to standardized suicide risk assessments.

4.2. Limitations

The present study has some limitations that need to be addressed. One limitation is that there may be a ‘selection bias’ in our sample, i.e., health workers who favor suicide prevention and suicide risk assessments may be most motivated to answer the survey, including possible social desirability bias. Another shortcoming is that we do not have information about the response rate, i.e., the exact number of health workers who declined participation. The electronic survey we applied could not provide us with this information, and we have also relied on a relatively small and heterogeneous sample. Unfortunately, the questionnaire and the measures we used were not validated. We were not able to control for confounding variables such as prior exposure to patient suicide, years of post-graduate training, and departmental policies. Nor did we obtain any information about the potential influence of personal experiences, personality traits, or cultural factors, which may influence attitudes. We also acknowledge that the findings are exploratory and hypothesis-generating, rather than confirming stable attitudinal patterns. Future research would benefit from drawing on a mixed-methods approach in order to obtain more in-depth information about factors that influence attitudes.

5. Conclusions

The present study aimed to investigate mental health workers’ views of suicide risk assessments. We found that mental health workers in general expressed confidence in suicide prevention. However, there was skepticism towards the Norwegian guidelines and standardized suicide risk assessments. The psychologists and doctors were significantly more skeptical than other professions. Furthermore, there was a significant difference between hospitals in our study. Methodological limitations should be taken into consideration, and the findings should be considered exploratory and hypothesis-generating. There is a need to carefully evaluate recent Norwegian guidelines. Future research should further explore health workers’ concerns about standardized suicide risk assessments.

Author Contributions

Conceptualization, M.B., S.K. and R.W.; methodology, M.B. and R.W.; formal analysis, M.B.; data curation, M.B.; writing—original draft preparation, M.B., S.K. and R.W.; writing—review and editing, M.B., L.L., S.K. and R.W.; supervision, M.B., L.L. and R.W.; project administration, M.B. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding. The APC was paid by the Publication Fund of UiT The Arctic University of Norway.

Institutional Review Board Statement

Ethical review and approval were not required for this study due to Norwegian Legal Regulations [Law on Medical and Health Research (Health Research Act)]: https://lovdata.no/dokument/NL/lov/2008-06-20-44, accessed on 24 February 2026. Guidance from the National Research Ethics Committee (NEM) states that “Anonymous data are not considered health information and therefore fall outside the scope of the Act.” and “For research projects that fall outside the Health Research Act, there is no requirement for prior ethical approval from REK (the Regional Committees for Medical and Health Research Ethics).” (Translated from Norwegian): https://www.forskningsetikk.no/retningslinjer/med-helse/helseforskningslovens-saklige-virkeomrade/?utm_source=chatgpt.com, accessed on 24 February 2026.

Informed Consent Statement

By completing the questionnaire, the participants consented to participate in the study. A separate written consent was not required due to the fact that the survey was completely anonymous. The questionnaire will be only used for collective analysis.

Data Availability Statement

The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.

Conflicts of Interest

The authors declare no conflicts of interest.

Appendix A

Table A1. Questionnaire (translated into English).
Table A1. Questionnaire (translated into English).
Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
If patients really want to commit suicide, they keep quiet
Patients have a right to commit suicide if they want to
Most suicides can be prevented
Suicide risk assessments have limited utility since you can never predict a suicide
There is no certain way to find out who will commit suicide
Assessing suicide risk is a demanding task for health workers
Assessing suicide risk is a demanding task for patients
Suicide is understandable for patients with serious illness
Talking with patients about suicide ideation can increase the risk of suicide
Suicide during admission is due to a lack of preventive strategies
Suicide during admission is due to a lack of suicide risk assessments
Suicide during admission is due to a lack of staff
Even if you know who will commit suicide, it is impossible to know when it will occur
National guidelines for suicide prevention in mental health care have received criticism for relying too heavily on suicide risk assessments. This critique is warranted.
It is important to identify risk factors for suicide (e.g., prior attempts and substance abuse)
For suicide risk assessment, it is sufficient to ask the patient about suicide thoughts or plans
For suicide risk assessment, a short evaluation is sufficient
Standardized questions about suicide are mechanical and can affect listening skills

References

  1. World Health Organization. Suicide Worldwide in 2019: Global Health Estimates. 2021. Available online: https://www.who.int/publications/i/item/9789240026643 (accessed on 4 November 2025).
  2. Walby, F.A.; Myhre, M.Ø.; Kildahl, A.T. Contact with Mental Health Services Prior to Suicide: A Systematic Review and Meta-Analysis. Psychiatr. Serv. 2018, 69, 751–759. [Google Scholar] [CrossRef] [Scilit]
  3. Stene-Larsen, K.; Raknes, G.; Engdahl, B.; Qin, P.; Mehlum, L.; Strøm, M.S.; Reneflot, A. Suicide trends in Norway during the first year of the COVID-19 pandemic: A register-based cohort study. Eur. Psychiatry 2022, 65, e26. [Google Scholar] [CrossRef] [Scilit]
  4. Krvavac, S.; Bystad, M.; Wynn, R.; Bukholm, I.R.K.; Jansson, B. Characteristics of Patients Who Complete Suicide and Suicide Attempts While Undergoing Treatment in Norway: Findings from Compensation Claims Records. Int. J. Environ. Res. Public. Health 2023, 20, 4083. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  5. Eurostat. Deaths by Suicide in the EU Down by 13% in a Decade. Luxembourg: European Union. 2024. Available online: https://ec.europa.eu/eurostat/en/web/products-eurostat-news/w/edn-20240909-1 (accessed on 27 November 2025).
  6. Stoor, J.P.A.; Kaiser, N.; Jacobsson, L.; Salander Renberg, E.; Silviken, A. ‘We are like lemmings’: Making sense of the cultural meaning(s) of suicide among the Indigenous Sami in Sweden. Int. J. Circumpolar Health 2015, 74, 27669. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  7. Espeland, K.; Hjelmeland, H.; Loa Knizek, B. A call for change from impersonal risk assessment to a relational approach: Professionals’ reflections on the national guidelines for suicide prevention in mental health care in Norway. Int. J. Qual. Stud. Health Well-Being 2021, 16, 1868737. [Google Scholar] [CrossRef] [Scilit]
  8. Godin, P. ‘You don’t tick boxes on a form’: A study of how community mental health nurses assess and manage risk. Health Risk Soc. 2004, 6, 347–360. [Google Scholar] [CrossRef] [Scilit]
  9. Turecki, G.; Brent, D.A. Suicide and suicidal behaviour. Lancet. 2016, 387, 1227–1239. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  10. Sadek, J. A Clinician’s Guide to Suicide Risk Assessment and Management; Springer: Cham, Switzerland, 2019. [Google Scholar]
  11. Gonçalves, P.A.; Lopez Molina, M.; de Azevedo Cardoso, T.; Campos Mondin, T.; Azevedo da Silva, R.; Jansen, K.; Dornellas de Barros, M.M.; Nobre Dos Santos, É.; Rodrigues de Aguiar, K.; Dias de Mattos Souza, L. Incidence and Risk Factors for Suicide Attempts in Patients Diagnosed with Major Depressive Disorder. Psychol. Res. Behav. Manag. 2020, 13, 1147–1157. [Google Scholar] [CrossRef] [Scilit]
  12. NICE. National Institute for Health and Care Excellence. 2022. Available online: https://www.nice.org.uk/guidance/ng225/chapter/Recommendations#risk-assessment-tools-and-scales (accessed on 4 November 2025).
  13. Wasserman, D.; Rihmer, Z.; Rujescu, D.; Sarchiapone, M.; Sokolowski, M.; Titelman, D.; Zalsman, G.; Zemishlany, Z.; Carli, V. European Psychiatric Association. The European Psychiatric Association (EPA) guidance on suicide treatment and prevention. Eur. Psychiatry 2012, 27, 129–141. [Google Scholar] [CrossRef] [Scilit]
  14. Jacobs, D.G.; Baldessarini, R.J.; Conwell, Y.; Fawcett, J.A.; Horton, L.; Meltzer, H.; Pfeffer, C.R.; Simon, R.I. Assessment and treatment of patients with suicidal behaviors. APA Pract. Guidel. 2010, 1, 183. [Google Scholar]
  15. Norwegian Directorate of Health and Social Affairs. National Guidelines for Prevention of Suicide in Mental Health Care; Norwegian Directorate of Health and Social Affairs: Oslo, Norway, 2008. [Google Scholar]
  16. European Psychiatric Association. EPA Statement of Suicide Prevention. 2019. Available online: https://www.europsy.net/app/uploads/2019/09/Press-release-Suicide-10-Sept-FINAL.pdf (accessed on 27 November 2025).
  17. American Psychiatric Association. Suicide Prevention. Available online: https://www.psychiatry.org/patients-families/suicide-prevention (accessed on 27 November 2025).
  18. National Institute for Health and Care Excellence. Suicide Prevention. Quality Statements Quality statements|Suicide prevention|Quality standards|NICE. 2019. Available online: https://www.nice.org.uk/guidance/qs189/chapter/Quality-statements (accessed on 27 November 2025).
  19. Hjelmeland, H.; Hagen, J.; Espeland, K.; Nygaard, T.U.; Knizek, B.L. Guidelines do not prevent suicide. Tiddskr. Nor. Laegefor. 2018, 138. [Google Scholar] [CrossRef] [Scilit]
  20. Hjelmeland, H.; Hagen, J.; Knizek, B.L. Suicide prevention in mental health care—Time for new ideas? Tidsskr. Nor. Laegeforen. 2014, 134, 1222. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  21. Hawton, K.; Lascelles, K.; Pitman, A.; Gilbert, S.; Silverman, M. Assessment of suicide risk in mental health practice: Shifting from prediction to therapeutic assessment, formulation, and risk management. Lancet Psychiatry 2022, 9, 922–928. [Google Scholar] [CrossRef] [Scilit]
  22. Cohen, A.S.; Fedechko, T.; Schwartz, E.K.; Le, T.P.; Foltz, P.W.; Bernstein, J.; Cheng, J.; Rosenfeld, E.; Elvevåg, B. Psychiatric Risk Assessment from the Clinician’s Perspective: Lessons for the Future. Community Ment. Health J. 2019, 55, 1165–1172. [Google Scholar] [CrossRef] [Scilit]
  23. Schulz, P.; Zapata, I.; Huzij, T. Examination of medical student and physician attitudes towards suicide reveals need for required training. Front. Public Health 2024, 12, 1331208. [Google Scholar] [CrossRef] [Scilit]
  24. Gunnarsson, N.V.; Hedman, K. Navigating suicidality: Swedish social workers’ approaches to identifying and supporting suicidal clients. Nord. Soc. Work. Res. 2024, 1–14. [Google Scholar] [CrossRef] [Scilit]
  25. Dubue, J.D.; Hanson, W.E. Psychologists’ experiences conducting suicide risk assessments: A phenomenological study. Can. J. Couns. Psychoth. 2020, 54, 819–845. [Google Scholar] [CrossRef] [Scilit]
  26. Roush, J.F.; Brown, S.L.; Jahn, D.R.; Mitchell, S.M.; Taylor, N.J.; Quinnett, P.; Ries, R. Mental Health Professionals’ Suicide Risk Assessment and Management Practices. Crisis 2018, 39, 55–64. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  27. Wynn, R.; Kvalvik, A.M.; Hynnekleiv, T. Attitudes to coercion at two Norwegian psychiatric units. Nord. J. Psychiatry 2011, 65, 133–137. [Google Scholar] [CrossRef] [Scilit]
  28. Wynn, R.; Myklebust, L.H.; Stensland, G.Ø. Attitudes to the use of diagnostic instruments among clinicians in northern Norway. Aust. N. Z. J. Psychiatry 2005, 39, 313. [Google Scholar] [CrossRef]
  29. The Norwegian National Research Ethics Committees. Helseforskningslovens Saklige Virkeområde. 2021. Available online: https://www.forskningsetikk.no/retningslinjer/med-helse/helseforskningslovens-saklige-virkeomrade/?utm_source=chatgpt.com (accessed on 27 November 2025).
  30. Norwegian Directorate of Health. National Guidelines for Prevention of Suicide in Mental Health Care and Substance Use Treatment; Norwegian Directorate of Health: Oslo, Norway, 2024; Available online: https://www.helsedirektoratet.no/retningslinjer/selvmordsforebygging-i-psykisk-helsevern-og-tsb (accessed on 4 November 2025).
  31. Picard, E.H.; Rosenfeld, B. How Clinicians Incorporate Suicide Risk Factors Into Suicide Risk Assessment. Crisis 2021, 42, 100–106. [Google Scholar] [CrossRef] [Scilit]
  32. Mulder, R. Problems with Suicide Risk Assessment; Sage Publications Sage UK: London, UK, 2011; pp. 605–607. [Google Scholar]
  33. Cialdini, R.B. Influence: Science and Practice, 3rd ed.; HarperCollins College Publishers: New York, NY, USA, 1993; p. 253. [Google Scholar]
  34. Undrill, G. The risks of risk assessment. Adva Psychiatr. Treat. 2007, 13, 291–297. [Google Scholar] [CrossRef] [Scilit]
  35. Yakeley, J. Psychodynamic approaches to suicide and self-harm. BJPsych Adv. 2018, 24, 37–45. [Google Scholar] [CrossRef] [Scilit]
  36. Gibbons, R. Eight ‘truths’ about suicide. BJPsych Bull. 2023, 48, 350–354. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  37. Nugent, A.C.; Ballard, E.D.; Park, L.T.; Zarate, C.A., Jr. Research on the pathophysiology, treatment, and prevention of suicide: Practical and ethical issues. BMC Psychiatry 2019, 19, 332. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  38. Arowosegbe, A.; Oyelade, T. Suicide risk assessment and prevention tools in the UK: Current landscape and future directions. Psychiatry Int. 2023, 4, 354–369. [Google Scholar] [CrossRef] [Scilit]
Table 1. Demographic characteristics of the sample (N = 183).
Table 1. Demographic characteristics of the sample (N = 183).
VariableCategoryn (%)
GenderMen60 (32.8%)
Women123 (67.2%)
Age group20–50 years110 (60.1%)
50–70 years73 (39.9%)
ProfessionDoctors45 (24.6%)
Psychologists68 (37.2%)
Nurses33 (18.0%)
Social workers37 (20.2%)
HospitalUniversity Hospital of North Norway61 (33.3%)
Helgeland Hospital28 (15.3%)
Innlandet Hospital Trust94 (51.4%)
Clinical experience<15 years91 (49.7%)
≥15 years92 (50.3%)
Table 2. Mean, median, and standard deviation for all questionnaire items for the full sample (N = 183).
Table 2. Mean, median, and standard deviation for all questionnaire items for the full sample (N = 183).
QuestionMMedSDM IHTM UNNM HH
(1) If patients really want to commit suicide, they keep quiet2.833.001.312.842.812.62
(2) Patients have the right to commit suicide if they want to2.793.001.232.662.922.96
(3) Most suicides can be prevented3.714.000.773.713.773.62
(4) Suicide risk assessments have limited utility since you can never predict a suicide 2.834.001.362.962.832.38
(5) There is no certain way to find out who will commit suicide3.634.000.873.703.663.23
(6) Assessing suicide risk is a demanding task for health workers2.994.001.312.812.873.12
(7) Assessing suicide risk is a demanding task for patients2.573.001.352.742.192.92
(8) Suicide is understandable for patients with serious illness 3.454.000.953.473.643.04
(9) Talking with patients about suicide ideation can increase the risk of suicide1.241.000.671.151.041.96
(10) Suicide during admission is due to a lack of preventive strategies2.543.001.252.502.423.04
(11) Suicide during admission is due to a lack of suicide risk assessments2.111.001.221.991.942.92
(12) Suicide during admission is due to a lack of staff2.653.001.162.482.743.12
(13) Even if you know who will commit suicide, it is impossible to know when it will occur 3.624.000.773.683.603.54
(14) The national guidelines for suicide prevention in mental health care have received criticism for relying too heavily on suicide risk assessments. This critique is warranted. 3.404.001.013.443.542.96
(15) For suicide risk assessment, it is sufficient to ask the patient about suicide thoughts or plans. 1.661.001.091.511.602.23
(16) It is important to identify risk factors for suicide (e.g., prior attempts and substance abuse) 3.784.000.683.823.793.63
(17) For suicide risk assessment, a short evaluation is sufficient 2.623.001.322.502.912.50
(18) Standardized questions about suicide are mechanical and can affect listening skills3.014.001.233.172.912.63
Abbreviations: M = Mean, Med = Median, SD = Standard Deviation, IHT = Innlandet Hospital Trust, UNN = University Hospital of North Norway, HH = Helgeland Hospital.
Table 3. The differences between professions and the perception of the Norwegian guidelines.
Table 3. The differences between professions and the perception of the Norwegian guidelines.
MMedSD
The national guidelines for suicide prevention in mental health care have received criticism for relying too heavily on suicide risk assessments. This critique is warrantedMDs3.674.000.79
Clin. Psy.3.574.000.98
Nurses3.154.001.27
Social W.2.973.000.91
Abbreviations: M = Mean, Med = Median, SD = Standard Deviation, MDs = Medical Doctors, Clin. Psy. = Clinical Psychologists, Social W. = Social Workers.
Table 4. The differences between the workplace and the perception of the Norwegian guidelines.
Table 4. The differences between the workplace and the perception of the Norwegian guidelines.
MMedSD
The Norwegian guidelines for suicide prevention in mental health care have received criticism for relying too heavily on suicide risk assessments. This critique is warrantedUNN3.544.001.00
HH2.963.000.94
IHT3.444.001.02
Difference = (p = 0.001, r = 0.43)
Abbreviations: M = Mean, Med = Median, SD = Standard Deviation, UNN = University Hospital of North Norway, HH = Helgeland Hospital, IHT = Innlandet Hospital Trust.
Table 5. The differences between the perception of risk factors and staff at different hospitals.
Table 5. The differences between the perception of risk factors and staff at different hospitals.
MMedSD
It is important to identify risk factors for suicide (e.g., prior attempts and substance abuse)UNN3.794.000.70
HH3.634.000.68
IHT3.824.000.67
Difference = (H (2) = 8.28, p = 0.016)
Abbreviations: M = Mean, Med = Median, SD = Standard Deviation, UNN = University Hospital of North Norway, HH = Helgeland Hospital, IHT = Innlandet Hospital Trust.
Table 6. The differences between workplace and perception of standardized questions.
Table 6. The differences between workplace and perception of standardized questions.
MMedSD
Standardized questions about suicide are mechanical and can affect listening skillsUNN2.914.001.32
HH2.633.001.14
IHT3.174.001.19
Difference = (H (2) = 7.93, p = 0.019)
Abbreviations: M = Mean, Med = Median, SD = Standard Deviation, UNN = University Hospital of North Norway, HH = Helgeland Hospital, IHT = Innlandet Hospital Trust.
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Bystad, M.; Lien, L.; Krvavac, S.; Wynn, R. Health Workers’ Perceptions of Suicide Risk Assessments: A Survey Study from Norway. Psychiatry Int. 2026, 7, 56. https://doi.org/10.3390/psychiatryint7020056

AMA Style

Bystad M, Lien L, Krvavac S, Wynn R. Health Workers’ Perceptions of Suicide Risk Assessments: A Survey Study from Norway. Psychiatry International. 2026; 7(2):56. https://doi.org/10.3390/psychiatryint7020056

Chicago/Turabian Style

Bystad, Martin, Lars Lien, Sanja Krvavac, and Rolf Wynn. 2026. "Health Workers’ Perceptions of Suicide Risk Assessments: A Survey Study from Norway" Psychiatry International 7, no. 2: 56. https://doi.org/10.3390/psychiatryint7020056

APA Style

Bystad, M., Lien, L., Krvavac, S., & Wynn, R. (2026). Health Workers’ Perceptions of Suicide Risk Assessments: A Survey Study from Norway. Psychiatry International, 7(2), 56. https://doi.org/10.3390/psychiatryint7020056

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