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Widespread Screening in ED Detects Nearly Double the Suicidal Patients

WORCESTER, MA – Almost universal suicide risk screening conducted by emergency department nurses nearly doubled the number of patients who were positively identified as having thought about or attempted suicide, according to a new study.

The report published recently in the American Journal of Preventive Medicine noted that detection of suicide risk rose from 2.9% to 5.7% when screening among 236,791 patients went from 26% to 84%.

“Our study is the first to demonstrate that near-universal suicide risk screening can be done in a busy ED during routine care,” said lead author Edwin Boudreaux, PhD, of the University of Massachusetts (UMass) Medical School.

The research was part of the $12 million Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study. Nurses at eight participating EDs in seven states were trained to administer a brief patient screening tool focusing on three suicide risk factors: depressive symptoms, active suicidal ideation, and lifetime suicide attempts. A positive screen is defined as any individual who either confirmed active suicidal ideation, or reported a suicide attempt within the six months prior to the ED visit.

The study period from 2009 through 2014 encompassed three phases:

  • Treatment as Usual (Phase 1);
  • Universal Screening (Phase 2); and
  • Universal Screening + Intervention (Phase 3).

Data was collected during peak hours seven days of the week.

“The patients we identified through screening received additional evaluation and intervention resources they otherwise would not have received,” Boudreaux, professor of emergency medicine, psychiatry, and quantitative health sciences and vice chair of research for the Department of Emergency Medicine, said in a UMass press release. “In fact, with screening we identified a subset of patients whose suicidality was serious enough to warrant psychiatric inpatient treatment. What would have happened to them if they had been discharged? The conventional wisdom is that at least some of those individuals would have tried to kill themselves.”

An additional 90% of patients with positive screens were discharged with resources, including lists of community-based services, a self-help safety plan, and a wallet card with local suicide prevention lifeline numbers.

In the study’s final phase, patients with positive screens who agreed to participate received, after discharge, more intensive intervention through structured telephone calls with trained nurses.

“Universal suicide risk screening in the ED was feasible and led to a nearly twofold increase in risk detection,” study authors conclude. “If these findings remain true when scaled, the public health impact could be tremendous, because identification of risk is the first and necessary step for preventing suicide.”

ED-SAFE is funded by an initiative of the National Institute of Mental Health to develop evidence-based practice guidelines that will optimize the ED as an important setting in which to increase suicide risk detection and suicide prevention.