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ED intervention reduces suicide attempts in at-risk adults

An intervention initiated in the ED reduced suicide attempts among adults a recent suicide attempt or ideation, according to findings published in JAMA Psychiatry in conjunction with the American Association of Suicidology annual meeting.

“Because EDs treat many patients who are at risk for suicidal behavior, they are particularly important locations for suicide prevention. More than 4% of all ED visits are attributable to psychiatric conditions, and there are approximately 420,000 visits every year for intentional self-harm,” Ivan W. Miller, PhD, of Brown University, Butler Hospital, Providence, Rhode Island, and colleagues wrote. “These high-risk individuals are susceptible to suicide attempts after their ED visit. Also, a significant proportion of those who die by suicide received care in an ED in the period prior to death.”

To assess efficacy of an ED-initiated intervention for reduction of subsequent suicidal behavior, researchers conducted a multicenter study of eight EDs in the U.S. among 1,376 adults with a recent suicide attempt or ideation. Study participants underwent three sequential phases: treatment as usual from August 2010 to December 2011; universal screening from September 2011 to December 2012; and universal screening plus intervention from July 2012 to November 2013. The third phase consisted of a secondary suicide risk screening by an ED physician, discharge resources and post-ED phone calls focused on reducing suicide risk.

Overall, 20.9% of the cohort attempted suicide at least once.

Risk reduction did not significantly differ between the treatment-as-usual phase and screening phases (23% vs. 22%).

However, participants in the intervention phase exhibited a 5% absolute reduction in suicide attempt risk (23% vs. 18%), with a relative risk reduction of 20%, compared with the treatment-as-usual phase.

In the intervention phase, participants had 30% fewer suicide attempts than in the treatment-as-usual phase.

Negative binomial regression analysis indicated participants in the intervention phase had significantly fewer total suicide attempts than in the treatment-as-usual phase (IRR = 0.72; 95% CI, 0.52-1; P = .05), but no differences between the treatment-as-usual and screening phases (IRR = 1; 95% CI, 0.71-1.41).

“The modest positive outcomes observed in the ED-SAFE study add to a growing body of literature documenting that targeted efforts to recognize and actively intervene with individuals at high risk for suicide can be life-saving, but it may be of even greater import in calling attention to a collective societal blind spot with regard to the public health role of the modern ED,” Jeffrey A. Bridge, PhD, of the Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, and colleagues wrote in an accompanying editorial. “Now, we must ensure that the implicit message to patients at risk for suicide is that they are as welcomed in the ED as patients with chest pain or broken bones and are equally deserving recipients of standardized, algorithm-driven care.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.