Pharmacists’ implicit bias in suicide screening of male patients: an experimental vignette study

Background: Suicide, a leading yet preventable cause of death, disproportionately affects males and sexual minorities. Community pharmacists, given their expanding scope of practice, are well-positioned to screen for suicide risk; however, there is limited research examining how implicit bias may influence suicide screening. This study aims to examine implicit bias in the screening of potentially suicidal men based on perceived sexual orientation and subgroup membership as well as between registered pharmacists and pharmacy students/interns.Methods: A between subject experimental vignette design was used to assess implicit bias whereby the sexual orientation of the presenting patient was manipulated (straight vs gay) as well as subgroup membership for the gay category (twink vs bear). Each participant was presented with a random vignette describing a male patient with signs of potential suicide (physical symptoms and verbal). Participants reported their likelihood of screening the patient for suicide using the validated ASQ.Results: Participants (N = 155) reported their propensity to screen for suicide, with results suggesting implicit bias amongst registered but not student/intern pharmacists. Specifically, registered pharmacists were less likely to screen a straight male relative to a gay male. Suicide screening bias occurred against straight males when compared to both twinks and bears. Pharmacists did not discriminate between twinks and bears when screening.Conclusion: Results suggest pharmacists may minimise suicidal indicators amongst straight men, resulting in inaccurate risk assessments that may impede the identification and referral of at-risk patients to support systems. These results are concerning because men die by suicide at a higher rate than comparison groups such as women. Suicide prevention training, including recognising and diminishing implicit bias, is needed.