Emergency Departments Can Help Prevent Suicide

Suicide is the tenth leading cause of death in the United States and has increased in incidence 27 percent from 1999 to 2015. Interestingly, up to 40 percent of individuals who die by suicide visit an emergency department (ED) in the year before their death. In light of this touch point with at-risk patients, the Joint Commission issued a Sentinel Event alert in February 2016 asking that hospitals screen all medical patients for suicide risk, including patients presenting to EDs. However, the implementation of these screenings is often ill-supported given lacking resources to address mental health in most EDs in the United States.

A recent study published in JAMA Psychiatry found that a brief suicide prevention intervention initiated in the ED followed by a series of phone calls after ED discharge significantly reduced the overall number of patient suicide attempts during a 52-week follow-up.

“Many hospitals have initiated screening without the benefit of evidence-based tools and clinical pathways to guide them,” says Jeff Bridge, PhD, director of the Center for Suicide Prevention and Research at Nationwide Children’s Hospital and lead author of an invited editorial on the original research. “This study provides evidence that targeted efforts to recognize and actively intervene with individuals at high risk for suicide can be life-saving – there was a 30 percent reduction in suicide attempts in the intervention phase compared to the control group.”

The study authors created an intervention based on the Coping Long Term with Active Suicide program.

Following an initial positive screen, ED physicians performed a secondary standardized screening to evaluate suicide risk. Then, a self-administered safety plan was provided to patients by nursing staff. The end phase included a series of telephone calls to the participant.

While only 4 percent of participants received the secondary screening and 37 percent received the written safety plan, researchers looked to the number needed to treat (NNT) – an epidemiological measure used to communicate effectiveness. For the intervention in this study, the NNT was 22, which the authors note is comparable to other preventative interventions such as the influenza vaccine and statins for myocardial infarction.

“This study did not include children and adolescents younger than 18,” says Dr. Bridge, who is also a professor of Pediatrics, Psychiatry and Behavioral Health in The Ohio State University College of Medicine. “So, it will be important to study whether similar interventions delivered in pediatric populations will demonstrate similar effects. This population group is at even higher risk for suicide, and the implicit message to patients at risk of suicide in all age groups should be that they are as welcome in the ED as patients with broken bones and are equally deserving of standardized, algorithm-driven care.”

References:

1. Bridge JA, Horowitz LM, Campo JV. ED-SAFE- can suicide risk screening and brief intervention initiated in the emergency department save lives? JAMA Psychiatry. 1 Jun 2017;74(6):555-556.
2. Miller IW, Camargo CA Jr., Arias SA, Sullivan AF, Allen MH, Goldstein AB, Manton AP, Espinola JA, Jones R, Hasegawa K, Boudreaux ED, ED-SAFE Investigators. Suicide prevention in an emergency department population: the ED-SAFE study. JAMA Psychiatry. 1 Jun 2017;74(6):563-570.