Suicide Prevention in an Emergency Department Population

Abstract

Importance Suicide is a leading cause of deaths in the U.S. Although the emergency department (ED) is an opportune setting for initiating suicide prevention efforts, ED-initiated suicide prevention interventions remain underdeveloped. Objective To determine if an ED-initiated intervention reduces subsequent suicidal behavior. Design This multicenter study was composed of three sequential phases: 1) Treatment as Usual (TAU) (August 2010–December 2011), 2) Universal Screening (Screening) (September 2011–December 2012, and 3) Universal Screening + Intervention (Intervention)(July 2012-November 2013. Setting Eight EDs in the United States Participants Adults with a recent suicidal attempt or ideation were enrolled. Intervention Universal Screening consisted of universal suicide risk screening. The Intervention phase consisted of universal screening plus an intervention which included secondary suicide risk screening by the ED physician, discharge resources, and post-ED telephone calls focused on reducing suicide risk. Main Outcomes The primary outcome was suicide attempts (non-fatal and fatal) over the 52-week follow-up. The proportion and total number of attempts were analyzed. Results 1,376 participants (56% female, median age 36 years) were recruited. 288 participants (21%) made at least one suicide attempt. There were 548 total suicide attempts among participants. There were no significant differences in risk reduction between the TAU and Screening phases (23% vs. 22%). However, when compared to the TAU Phase, subjects in the Intervention phase showed a 5 % absolute reduction in suicide attempt risk (23% vs. 18%) with a relative risk reduction of 20%. Participants in the Intervention Phase had 30% fewer total suicide attempts than participants in the TAU Phase. Negative binomial regression analysis indicated that the participants in the Intervention Phase had significantly fewer total suicide attempts than participants in the TAU Phase (IRR, 0.72, 95%CI 0.52–1.00, P=0.05), but no differences between the TAU and Screening phases (IRR, 1, 95%CI 0.71–1.41, P=0.99). Conclusions Among at-risk patients in the ED, a combination of brief interventions administered both during and after the ED visit decreased post-ED suicidal behavior.

The prevalence and correlates of eating disorders in adult emergency department patients

“…Individuals who screen positive could be provided resources and then referred to appropriate outpatient providers. As mentioned earlier, prior studies have found that such programs involving emergency department screening and referral/intervention for other mental illnesses have been successful in reducing subsequent illness‐related symptoms and behaviors (Crawford et al, ; Miller et al, ). These findings suggest that there may be benefit to the development and use of similar programs for other illnesses including eating disorders.…”

Hospital Emergency Department Lethal Means Counseling for Suicidal Patients

“…This work supports recommendations to develop discharge protocols to improve lethal means counseling. 23,50–52 Though no single protocol has been tested, useful information appears in a recent consensus document published by the Suicide Prevention Resource Center 3 and Counseling on Access to Lethal Means offers online training. 53 …”

Cognitive behavioral therapy for suicide prevention (CBT‐SP): Implications for meeting standard of care expectations with suicidal patients

“…In addition to playing a prominent and central role in CBT‐SP, the CRP has been tested as a stand‐alone intervention, with results of two separate clinical trials indicating that the procedure reduces suicidal behaviors by 45–76% as compared with treatment as usual among acutely suicidal patients (Bryan, Mintz, Clemans, Leeson, et al, ; Stanley et al, ). A self‐guided version of the intervention, in which patients create a plan without the assistance or input of a trained healthcare professional, also reduces suicidal behavior as compared to treatment as usual, although to a lesser degree (i.e., 20% relative reduction; Miller et al, ).…”

“…Of those who die by suicide, half are actively engaged in mental healthcare at the time of their deaths (Fawcett, ), suggesting that a significant proportion of suicides could be prevented by improving the quality of mental healthcare for at‐risk individuals. Emerging data accumulated over the past decade suggest that relatively brief variants of cognitive behavioral therapy for suicide prevention (CBT‐SP) and procedures extracted from these treatments can lead to rapid and significant reductions in suicidal behaviors when used in a range of healthcare settings (Brown et al, ; Bryan et al, ; Miller et al, ; Rudd et al, ; Stanley et al, ). In recognition of these issues and emerging data, the National Action Alliance for Suicide Prevention (NAASP, ) recently published several recommendations for standard care with suicidal individuals across the following domains: identification and assessment, safety planning, means reduction, and caring contacts (see Table ).…”