Subsequent Suicide Attempts May Be Reduced by Emergency Department Interventions

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It is estimated that suicide is the cause of 1.2% of deaths in the United States, with 44,193 cases in 2015.
It is estimated that suicide is the cause of 1.2% of deaths in the United States, with 44,193 cases in 2015.

In a multicenter study supported by funding from the National Institute of Mental Health, researchers from multiple US universities found that an intervention initiated in the emergency department (ED) may reduce subsequent suicide attempts and risk.1

It is estimated that suicide is the cause of 1.2% of deaths in the United States, with 44,193 cases in 2015.2 In addition, rates of attempted suicide have been reported to exceed 1 million annually. Psychotherapeutic interventions to reduce suicide attempts require a significant amount of training, time, and money. Other approaches have led to mixed findings, which further underscores the need for novel interventions for suicide prevention.

Noting the approximately 420,000 annual ED visits for intentional self-harm, and the significant number of individuals who have received ED care before dying by suicide, the current authors propose the ED could serve an important role in suicide prevention.3,4 In the new study, they investigated the effect of an ED-based intervention on subsequent suicidal behaviors in 1376 adult patients (55.9% female; 67.4% non-Hispanic white; median age, 37 years), with a positive screening result for suicidal ideation or attempts during the week before admission to 1 of 8 EDs. The main outcome was suicide attempts during the 52-week period after the ED visit, as assessed by the Columbia Suicide Severity Rating Scale.

Participants received treatment as usual (TAU), screening, or screening plus intervention. The intervention included safety planning and information delivered by nurses in the ED, and up to 7 postdischarge telephone calls to the patient (and up to 4 to the patient's significant other) during the 52-week follow-up period.

The calls were based on a protocol from the Coping Long Term with Active Suicide Program and "focused on identifying suicide risk factors, clarifying values and goals, safety and future planning, facilitating treatment engagement/adherence, and facilitating patient-[significant other] problem-solving," wrote the authors.5

During follow-up, 20.9% of participants attempted suicide at least once, and a total of 548 suicide attempts occurred among all participants combined, including 224 in the TAU phase, 167 in the screening phase, and 157 in the intervention phase. There were significantly fewer attempts by participants in the intervention phase compared with those in the TAU phase (incidence rate ratio, 0.72; 95% CI, 0.52-1.00; P =.05). For patients in the intervention phase vs those in the TAU phase, a 5% absolute decrease in absolute risk was observed (23% vs 18%), as well as a 20% decrease in relative risk.

Although these findings have implications for potential suicide prevention strategies initiated in the ED, larger studies are needed to further investigate the effects of such interventions.

References

  1. Miller IW, Camargo CA Jr, Arias SA, et al. Suicide prevention in an emergency department population: the ED-SAFE study. JAMA Psychiatry. 2017; doi:10.1001/jamapsychiatry.2017.0678
  2. Drapeau CW, McIntosh JL; American Association of Suicidology. USA suicide: 2015 official final data. http://www.floridasuicideprevention.org/PDF/2015%20US%20Suicide%20Official%20Final%20Data%20AAS.pdf. Accessed July 27, 2017.
  3. Ting SA, Sullivan AF, Boudreaux ED, Miller I, Camargo CA Jr. Trends in US emergency department visits for attempted suicide and self-inflicted injury, 1993-2008 [published online May 2, 2012]. Gen Hosp Psychiatry. doi: 10.1016/j.genhosppsych.2012.03.020
  4. Da Cruz D, Pearson A, Saini P, et al. Emergency department contact prior to suicide in mental health patients [published online July 26, 2010]. Emerg Med J. doi: 10.1136/emj.2009.081869
  5. Miller IW, Gaudiano BA, Weinstock LM. The Coping Long Term with Active Suicide Program: description and pilot data [published online April 2, 2016]. Suicide Life Threat Behav. doi: 10.1111/sltb.12247

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