Can suicide intervention at the ED save lives?
Wednesday, June 07, 2017
Although many suicide attempts go unreported or untreated, surveys suggest that at least 1 million people in the United States intentionally try to kill themselves each year, and 45,000 are successful. Suicide is the 10th-leading cause of death in the U.S., and there are about 121 suicides each day, nearly one every 13 minutes.
In 2015, 494,169 people visited an emergency department (ED) for attempted suicide. Studies show those who attempt suicide are at risk of another suicide attempt or death within 30 days of discharge from an ED or inpatient psychiatric unit, and 70 percent of patients who leave the ED never attend their first outpatient appointment. About 37 percent of patients without a mental health or chemical dependency diagnosis who die by suicide have made an ED visit in the previous year.
A recent study in JAMA Psychiatry involving suicidal patients in EDs of eight hospitals revealed that intervention reduced suicide attempts among the at-risk ED patients. This report was one of several from the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study, led by Ivan Miller, professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University.
This multicenter study was composed of three sequential phases:
- a treatment as usual (TAU) phase from August 2010 to December 2011
- a universal screening phase from September 2011 to December 2012
- a universal screening plus intervention phase from July 2012 to November 2013
The intervention phase included secondary suicide risk screening by the ED physician, discharge resources and post-ED telephone calls focused on reducing suicide risk. The primary outcome of the study was suicide attempts (nonfatal and fatal) over the 52-week follow-up period.
A total of 1,376 participants were recruited, including 769 females (55.9 percent, median age of 37 years). A total of 288 participants (20.9 percent) made at least one suicide attempt, and there were 548 total suicide attempts among participants.
No significant differences in risk reduction between the TAU and screening phases (23 percent vs 22 percent, respectively) were noted. However, patients in the intervention phase showed a 5 percent absolute reduction in suicide attempt risk (23 percent vs. 18 percent), with a relative risk reduction of 20 percent.
Participants in the intervention phase had 30 percent fewer total suicide attempts than participants in the TAU phase. They also had significantly fewer total suicide attempts than participants in the TAU phase, but no differences between the TAU and screening phases were observed.
This study, possibly the largest intervention trial conducted in the U.S., revealed that among at-risk patients in the ED, a combination of brief interventions administered both during and after an ED visit decreased post-ED suicidal behavior. Although Miller would like to have seen an even stronger effect, he feels encouraged that this at-risk population was impacted with somewhat-limited intervention.
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