Important suicide risk factors may be missed in ED

TORONTO — Although ED physicians and psychiatrists rated certain suicide risk factors as important, chart review indicated they did not often document those risk factors.

“Despite the fact that we have a lot of research done and risk factors are well known to us as clinicians, it is still very difficult to us or impossible to predict death by suicide,” study researcher Taras Reshetukha, MD, of Queen’s University in Ontario, said during a presentation here. “The only tools we have are actual skills in clinical assessment, the gold standard in assessing patient risk of suicidal behavior. The whole idea behind suicide risk assessment is not to predict suicide from happening but rather to appreciate the basis of suicidality done through eliciting important risk factors that would allow us to implement well informed intervention for a particular patient.”

Taras Reshetukha

To identify what suicide risk factors ED physicians used to establish risk, what risk factors they considered most important and what factors were most often missed, researchers administered surveys to ED physicians and psychiatrists and reviewed 2,080 charts for patients who presented with suicidal behavior. Physicians rated risk factor importance on a scale of 0 to 3, with 3 being most important.

Analysis indicated that both ED physicians and psychiatrists rated bullying as a significant risk factor for suicide, however, neither group documented bullying in chart review, according to researchers.

While ED physicians rated abuse as an important risk factor, they documented it approximately 20% of the time, indicating it was often missed.

“The most interesting finding is that the most important factors rated by both groups were if patients had past attempts, the severity of attempts and family history of suicide, all rated around 3 on importance scale,” study researcher Nazanin Alavi, MD, of Queen’s University, said. “It is not often documented or assessed among ED doctors.”

Nazanin Alavi

According to analysis, previous suicide attempts were assessed 50% of the time and attempt severity was assessed 90% of the time, but family history was not assessed.

Researchers presented the study findings to ED physicians and psychiatrists and encouraged them to document the suicide risk factors that were shown to be missed most often.

“We suggested that risk factors be divided into three groups: 1) patient psychiatric history, so if we see a patient who is suicidal we take note of any current psychiatric problems they have; 2) environment, ask if they have any stressors, including bullying and abuse, and if they have any support; and 3) ask about suicide itself and if they have past history or family history,” Alvai said.

Reshetukha, Alavi and colleagues plan to apply this checklist to EDs as an additional tool to the gold standard and then assess what risk factors physicians are missing, if any, and conduct another chart review to improve suicide risk assessment. – by Amanda Oldt

Reference:

Reshetukha T, et al. P5-086. Presented at: American Psychiatric Association Annual Meeting; May 16-20, 2015; Toronto.

Disclosure: Reshetukha and Alavi report no relevant financial disclosures.