Competency of primary care providers to assess and manage suicide risk in Nepal: The role of emotional validation and invalidation techniques

Screening for suicide risk in primary care settings is a recommended strategy worldwide for suicide prevention. However, few studies examine which clinical behaviors on the part of primary care providers are most predictive of competency in suicide risk assessment and management. The current study used ratings on the Enhancing Assessment of Common Therapeutic Factors (ENACT) tool during observations of provider-patient role plays (N = 91) to understand how primary care providers' use of emotional validation and invalidation strategies associate with competency in assessing for and managing suicide risk. Structural equation modeling revealed that emotional validation by primary care providers (beta = 0.63, p < 0.001) was significantly associated with clinical competency for assessing and managing suicide risk. Scoring procedures on the ENACT that capture specific behavioral attributes had an improved model fit, compared to a general Likert scale version of ENACT scoring. This study suggests that training primary care providers on emotional validation strategies may improve their competency in suicide prevention. The findings also support assessing suicide prevention competency by documenting specific behaviors, rather than generic ratings such as "done poorly" or "done well." Future research rating interactions with actual patients and connecting competency with patient outcomes could help refine clinical training as well as our understanding of processes through which emotional validation and invalidation strategies contribute to more effective suicide prevention.