Tuesday, May 2, 2017

Emergency Department Intervention May Reduce Suicide Attempts in At-Risk Patients

A study published April 29 in JAMA Psychiatry reports that a multifaceted intervention incorporating screening, safety planning guidance, and periodic telephone follow-up can reduce the risk of suicidal behavior in at-risk individuals who present in the emergency department (ED).

The reductions were modest but clinically significant; compared with usual ED treatment, the number of patients who attempted suicide dropped by about 20% and the total number of suicide attempts dropped by about 30%.

“We would like to have had an even stronger effect, but the fact that we were able to impact attempts with this population and with a relatively limited intervention is encouraging,” said lead investigator Ivan Miller, Ph.D., a professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University, in a press statement.

For this three-phase study, Miller and colleagues enrolled 1,376 adults with a recent suicide attempt or ideation who presented at one of eight emergency departments across the United States. All patients enrolled during the first phase received treatment according to the usual and customary care at each ED; patients enrolled during the second phase received usual care plus a universal suicide risk screening assessment (the Patient Safety Screener); and patients in the third phase received universal screening plus a suicide intervention that included a secondary suicide risk screen, a self-administered safety plan provided by nursing staff, and weekly check-ins by phone after discharge for 52 weeks.

During the study period, there were 548 suicide attempts, with 288 patients making at least one attempt. There was no significant difference in attempt risk between the usual-care and universal-screening phases (23% and 22%, respectively). However, the risk dropped to 18% during the intervention phase. 

The study authors estimated that this reduction translated to a number needed to treat (NNT) of 22. “This level of risk reduction compares favorably with other interventions to prevent major health issues, including statins to prevent heart attack (NNT = 104), antiplatelet therapy for acute ischemic stroke (NNT = 143), and vaccines to prevent influenza in elderly individuals (NNT = 20),” Miller and colleagues wrote.

“We applaud the investigators for conducting a rigorous test of an innovative screening and intervention strategy to help reduce suicide risk in adult ED patients,” wrote Jeffrey Bridge, Ph.D., of Ohio State University and colleagues 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.”

For related information, see the Psychiatric News article “Group Unveils Strategy for Reducing Suicide Rate 20 Percent by 2025” and the Psychiatric Services article “An Emergency Department Intervention and Follow-Up to Reduce Suicide Risk in the VA: Acceptability and Effectiveness.”

(Image: iStock/MJFelt)


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