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Santa K, Dixon C, Ganga RN, Trainor G, Smith G, Furfie V, Brown H. Facilitating Access to Mental Health Services: A Stakeholder-Driven Improvement of the Children and Young People (CYP) as One Referral Platform. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:784. [PMID: 38929030 PMCID: PMC11203779 DOI: 10.3390/ijerph21060784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
(1) Background: Pre-pandemic, child and adolescent mental health service (CAMHS) referrals were paper based in Liverpool and Sefton (England, United Kingdom), causing delays in waiting times. The "CYP as One" online mental health referral platform was co-created to overcome these challenges. (2) Methods: This study aims to improve "CYP as One" accessibility and usability and, subsequently, support CAMHS to improve waiting times. The current study utilised the Living Lab approach. We conducted content analysis on completed online referrals extracted from the "CYP as One" platform. These findings were supplemented by seven online focus groups, with 16-19-year-old young people, parents of children under 16, and health service providers. Thematic analysis was conducted on all data. (3) Results: The thematic analysis returned seven themes, namely (i) "CYP as One" vs. Traditional Referrals, (ii) Gender and Language Dynamics, (iii) Digital Empathy in Action, (iv) the Influence of the Provider Perspective, (v) Age and Social Sensitivity, (vi) Enhancing Access to Information, and (vii) Boosting Admin and Clinical Efficiency. (4) Conclusions: Digital content that seeks to replace in-person referrals can provide adequate support to children and young people who have faced difficulties accessing mental health services.
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Affiliation(s)
- Kristof Santa
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L2 2ER, UK
| | - Chloe Dixon
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L2 2ER, UK
| | - Rafaela Neiva Ganga
- Liverpool Business School, Faculty of Business and Law, Liverpool John Moores University, Liverpool L1 2TZ, UK
| | - Gemma Trainor
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L2 2ER, UK
| | - Grahame Smith
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L2 2ER, UK
| | | | - Holly Brown
- Alder Hey Children’s Hospital, Liverpool L14 5AB, UK
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Brousseau-Paradis C, Genest C, Maltais N, Séguin M, Rassy J. Emergency department care experience of suicidal patients: A qualitative analysis of patients' perspectives. Int Emerg Nurs 2024; 74:101449. [PMID: 38669791 DOI: 10.1016/j.ienj.2024.101449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/24/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Individuals experiencing suicidal ideation or behavior frequently seek assistance at the emergency department (ED), yet the care they receive does not consistently align with their needs. This study explores the ED care experience of suicidal patients from their own perspective and offers recommendations to improve ED care for this population. METHOD This qualitative study uses a descriptive interpretative design. Semi-structured interviews were conducted with 7 individuals who sought care in an ED due to suicidal ideation or behavior. Transcripts were analyzed using thematic analysis. FINDINGS Participants' experiences were marked by an unsuited physical environment described as uncomfortable, noisy, and depressing. The organization of care was perceived as inadequate as patients complained about limited front-line access to mental health expertise, long waiting times, overworked staff, and inequities between patients with physical injuries and those with mental health concerns. Participants reported feelings of being trapped, left on their own and mistreated during their ED stay. Most found their care experience unhelpful or distressing, leaving them reluctant to reconsult. Specific recommendations based on patients' testimonials and literature are provided to enhance the ED care experience of suicidal patients. CONCLUSION This study highlights several areas for improvement of the ED care experience of suicidal patients. Changes in current practices are needed to offer suicidal patients the satisfying care experience they deserve.
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Affiliation(s)
- Camille Brousseau-Paradis
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Pavillon Roger-Gaudry, 2900 boul. Édouard-Montpetit, bureau S-750, H3T 1J4 Montreal, QC, Canada; Research Center of the University Institute in Mental Health of Montreal, 7331 Hochelaga Street, Montreal H1N 3V2, QC, Canada.
| | - Christine Genest
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada; Research Center of the University Institute in Mental Health of Montreal, Trauma Study Center, Montreal, QC, Canada; Center for Research and Intervention on Suicide, Ethical Issues and End-of- Life Practices, Montreal, QC, Canada.
| | - Nathalie Maltais
- Department of Health Sciences, University of Quebec at Rimouski, Rimouski, QC, Canada; Department of Psychoeducation and Psychology, University of Quebec at Outaouais, Gatineau, QC, Canada.
| | - Monique Séguin
- Department of Psychoeducation and Psychology, University of Quebec at Outaouais, Gatineau, QC, Canada; Douglas Mental Health University Institute, Montreal, QC, Canada.
| | - Jessica Rassy
- Research Center of the University Institute in Mental Health of Montreal, 7331 Hochelaga Street, Montreal H1N 3V2, QC, Canada; Quebec Network on Suicide, Mood Disorders and Associated Disorders, Montreal, QC, Canada; Quebec Network on Nursing Intervention Research, Montreal, QC, Canada; School of Nursing, University of Sherbrooke, Longueuil, QC, Canada.
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Yurdadön C, Bruffaerts R, Sabbe M, Demyttenaere K, Peeters E, Gericke F, Voorspoels W. Transition to suicide ideation and attempt among emergency room patients. BJPsych Open 2024; 10:e88. [PMID: 38634324 PMCID: PMC11060087 DOI: 10.1192/bjo.2024.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/24/2024] [Accepted: 02/07/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Suicidal thoughts and behaviours (STB) represent a persistent and serious public health problem, and suicide is among the leading causes of death worldwide. We focus on predictors of transition rates and time courses through the STB spectrum among psychiatric emergency room (PER) patients. AIMS We aimed to investigate (a) whether currently suicidal patients had prior referrals to the PER, (b) for which reason they were previously referred to the PER and (c) the timing of this referral. METHOD We performed a retrospective study spanning 20 years with 24 815 PER referrals. Descriptive statistics of patients' sociodemographic and clinical characteristics are provided and expressed as weighted proportions and means. Logistic regression was used to identify risk profiles of patients who had a higher chance of being referred for reasons of STB given their PER history. Multiple imputation and data weighting techniques were implemented. RESULTS STB among PER patients was persistent and led to repeated referrals (up to five times more likely), often within a short period (18% <1 month). Those previously referred for ideation/plan had 66% higher risk of making the transition to suicide attempt, with 25% making this transition within a month after previous referral. This is similar to the transition from depressed mood to suicide ideation/plan. CONCLUSIONS STBs in PER patients are persistent and lead to repeated referrals, often within a short period, including transitions to more severe forms of STB.
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Affiliation(s)
| | | | | | | | - Elke Peeters
- Department Medical Affairs, Janssen-Cilag NV, Beerse, Belgium
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4
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Pollak OH, Shin KE, Baroni A, Gerson RS, Bell KA, Tezanos KM, Fernandes SN, Robinaugh DJ, Schacter DL, Spirito A, Cha CB. An examination of episodic future thinking in the emergency department among youth experiencing suicidal thoughts and behaviors. Eur Child Adolesc Psychiatry 2024; 33:923-933. [PMID: 37162586 DOI: 10.1007/s00787-023-02219-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/22/2023] [Indexed: 05/11/2023]
Abstract
Youth experiencing suicidal thoughts and/or behaviors (STBs) frequently present to emergency departments for acute psychiatric care. These settings offer a transitory yet pivotal opportunity to assess, intervene on, and plan continued care for STBs. This study examined a clinically relevant, understudied aspect of psychological functioning among youth experiencing STBs in the emergency department: episodic future thinking, or the ability to imagine discrete autobiographical future events. A sample of 167 youths (10-17 years) presenting to a pediatric psychiatric emergency department for STBs completed a performance-based measure of episodic future thinking assessing richness in detail and subjective characteristics of imagined future events. STB recurrence was assessed 6 months later. Immediately following a suicide-related crisis, youth demonstrated mixed abilities to imagine their future: they generated some concrete future event details but did not subjectively perceive these events as being very detailed or likely to occur. Older adolescents (i.e., 15-17) generated more episodic details than pre-/younger adolescents (i.e., 10-14), particularly those pertaining to actions or sensory perceptions. There was no evidence linking less detailed episodic future thinking and greater likelihood of STBs following the emergency department visit; instead, hopelessness was a more robust risk factor. Findings underscore the importance and clinical utility of better understanding the psychological state of youth during or immediately following a suicide-related crisis. In particular, assessing youths' future thinking abilities in the emergency department may directly inform approaches to acute care delivery.
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Affiliation(s)
- Olivia H Pollak
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC, 27599, USA.
| | - Ki Eun Shin
- Department of Behavioral Sciences, Long Island University, Post Campus, Brookville, NY, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Ruth S Gerson
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Kerri-Anne Bell
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Katherine M Tezanos
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | | | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Christine B Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
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Gürü M, Özensoy HS. Patterns and Outcomes of Traumatic Suicides: A Retrospective Study of 132 Patients Admitted to a Turkish Medical Center. Med Sci Monit 2024; 30:e943505. [PMID: 38414227 PMCID: PMC10910862 DOI: 10.12659/msm.943505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/24/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Patients who have attempted suicide by traumatic mechanisms and who present to the Emergency Department (ED) are important due to their severity and high mortality. This retrospective study aimed to evaluate the presentation 132 cases of attempted suicide admitted to a hospital ED in Ankara, Turkey, between September 2022 and August 2023. MATERIAL AND METHODS This retrospective study assessed data on 132 adult patients who presented at the ED of Ankara City Hospital due to attempted suicide by traumatic method during a 1-year study period. The descriptive characteristics of the cases, their chronic psychiatric diseases, and the characteristics of their injuries were analyzed based on the duration of stay in the ED and hospital as outcome measures. RESULTS Among our study population, 67% were men and 33% were women, and 52% had a previous psychiatric diagnosis. Incision was the predominant trauma mechanism (n=102, 77.3%). Patients with upper-extremity injuries had shorter stays in the ED (P=0.013), while those injured in with motor vehicle-related injuries and those falling from height stayed in the hospital longer (P=0.018). CONCLUSIONS In the traumatic suicides discussed, upper-extremity injuries with incision predominated. Upper-extremity injuries had shorter ED treatment times. Those injured by falling from heights or by motor vehicles required longer clinical care in the hospital.
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Affiliation(s)
- Meltem Gürü
- Health Care Center, Clinic of Psychiatry, Gazi University Rectorate Campus, Gazi University, Ankara, Turkey
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Betz ME, Meza K, Friedman K, Moceri-Brooks J, Johnson ML, Simonetti J, Baker JC, Bryan CJ, Anestis MD. 'Whether it's your weapon or not, it's your home': US military spouse perspectives on personal firearm storage. BMJ Mil Health 2023:e002591. [PMID: 38135459 DOI: 10.1136/military-2023-002591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION In the USA, an estimated 45% of veterans personally own firearms. Firearm access increases the risk of suicide, so suicide prevention efforts in the US Department of Defense (DoD) focus on lethal means safety, including reducing firearm access. Spouse input may enhance effective messaging and intervention delivery of lethal means safety. This study used qualitative methods to explore the perspectives of military spouses or partners on personal firearm storage, including at-home decisions, on-base storage and existing messaging from the DoD. MATERIALS AND METHODS Qualitative data were obtained using 1:1 interviews and focus groups with spouses/partners of US military service members (active duty, Reserve, National Guard, recently separated from the military) and representatives from military support organisations. Sessions focused on personal firearm storage (at home or on military installations) and military messaging around secure firearm storage and firearm suicide prevention. Data were analysed using a team-based, mixed deductive-inductive approach. RESULTS Across 56 participants (August 2022-March 2023), the themes were variability in current home firearm storage and spousal participation in decision-making; uncertainty about firearm storage protocols on military installations; mixed awareness of secure firearm storage messaging from the military; and uncertainty about procedures or protocols for removing firearm access for an at-risk person. CONCLUSION US military spouses are important messengers for firearm safety and suicide prevention, but they are currently underutilised. Tailored prevention campaigns should consider spousal dynamics and incorporate education about installation procedures.
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Affiliation(s)
- Marian E Betz
- Department Emergency Medicine, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
- Geriatric Research Education and Clinical Center, VA Eastern Colorado Health Care System, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - K Meza
- Department Emergency Medicine, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - K Friedman
- Department Emergency Medicine, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - J Moceri-Brooks
- New Jersey Gun Violence Research Center, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - M L Johnson
- Department Emergency Medicine, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - J Simonetti
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Veterans Health Administration, Aurora, Colorado, USA
| | - J C Baker
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - C J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, New York, USA
| | - M D Anestis
- New Jersey Gun Violence Research Center, Rutgers School of Public Health, Piscataway, New Jersey, USA
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Cunningham JK, Solomon TGA, Ritchey J, Weiss BD. Alcohol Use Disorder Visits and Suicide Ideation Diagnosis: Racial/Ethnic Differences at Emergency Departments. Am J Prev Med 2023; 65:1113-1123. [PMID: 37348661 DOI: 10.1016/j.amepre.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 06/16/2023] [Accepted: 06/18/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Nationally, suicide ideation prevalence is comparable among White, American Indian/Alaska Native, Black, and Hispanic adults experiencing alcohol use disorder. This study examines whether such comparability extends to the probability of receiving a suicide ideation diagnosis when presenting with alcohol use disorder at emergency departments. The probability of hospitalization following such diagnosis is examined as well. METHODS National Emergency Department Sample (2019) data were used. Logistic and multilevel logistic regression analyses were performed in 2022-2023 with suicide ideation diagnosis and subsequent hospitalization as the outcome variables. Control variables included demographics, payor, alcohol use disorder level, comorbidities, and emergency department facility. Adjusted probabilities were computed. RESULTS Age-adjusted probabilities of suicide ideation diagnoses for American Indian/Alaska Native, Black, and Hispanic patients with alcohol use disorder were 5.4%, 6.7%, and 4.9% (95% CIs=3.7, 7.1; 6.0, 7.4; 4.4, 5.4), respectively; all less than that for White counterparts (8.7%; 95% CI=8.2, 9.2). Among patients with alcohol use disorder plus suicide ideation diagnoses, the age-adjusted probability of hospitalization for American Indians/Alaska Natives (32.4%; 95% CI=20.9, 44.0) was less than that for Whites, Blacks, and Hispanics (49.8%, 52.3%, and 49.9%; 95% CIs=46.7, 52.8; 47.1, 57.5; and 43.9, 55.8, respectively). In regressions with multiple control variables, the racial/ethnic differences remained statistically significant (p<0.05). CONCLUSIONS Diagnosis of suicide ideation, a key step in emergency department suicide prevention care, occurred significantly less often for patients of color with alcohol use disorder than for White counterparts. American Indians/Alaska Natives, the racial/ethnic group known to have the nation's highest suicide rate, had the lowest probability of being hospitalized after a diagnosis of alcohol use disorder plus suicide ideation.
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Affiliation(s)
- James K Cunningham
- Department of Family and Community Medicine, The University of Arizona, Tucson, Arizona; American Indian Research Center for Health, The University of Arizona, Tucson, Arizona.
| | - Teshia G Arambula Solomon
- Department of Family and Community Medicine, The University of Arizona, Tucson, Arizona; American Indian Research Center for Health, The University of Arizona, Tucson, Arizona
| | - Jamie Ritchey
- Tribal Epidemiology Center, Inter Tribal Council of Arizona, Inc., Phoenix, Arizona
| | - Barry D Weiss
- Department of Family and Community Medicine, The University of Arizona, Tucson, Arizona
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Soderlund PD, Cheung EH, Cadiz MP, Siddiq H, Yerstein M, Lee S, Wells K, Heilemann MV. Bridging the gap: a qualitative study of providers' perceptions of a partnered crisis follow-up program for suicidal patients post-emergency department discharge. BMC Psychiatry 2023; 23:854. [PMID: 37978360 PMCID: PMC10655296 DOI: 10.1186/s12888-023-05106-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/11/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Effective interventions are needed to address suicide risk following discharge from the hospital emergency department or inpatient setting. Studies that examine follow-up contact methods show promise, but little is known about how follow-up programs are implemented in the real world and who is benefitting. The purpose of this formative evaluation and analysis was to gain insight about the usefulness and value of a partnered suicide prevention follow-up program (academic medical center emergency department partnered with a regional suicide prevention center) from the standpoint of psychiatry resident physicians providing direct care and suicide prevention center crisis counselors making follow-up outreach telephone calls to patients. METHODS A qualitative thematic analysis was conducted with focus group data from a convenience sample of psychiatry residents who performed consultations in the emergency department setting and counselors at the suicide prevention center crisis follow-up program. Focus group sessions, using semi-structured question guides, were completed at each participant group's workplace. Grounded theory techniques were used to guide coding and analytic theme development. RESULTS Analyses resulted in four overarching themes: valuing the program's utility and benefit to patients, desiring to understand what happens from emergency department discharge to program follow-up, having uncertainty about which patients would benefit from the program, and brainstorming to improve the referral process. Psychiatry residents appreciated the option of an "active" referral service (one that attempts to actively engage a patient after discharge through outreach), while suicide prevention crisis counselors valued their ability to offer a free and immediate service that had potential for fostering meaningful relationships. Both participant groups desired a better understanding of their partner's program operations, a uniform and smooth referral process, and awareness of who may or may not benefit from program services. CONCLUSION Results revealed the need for improved communication and implementation, such as expanded inter-agency contacts, consistent provider training, more documentation of the requirements and rules, a consistent message about program logistics for patients, and coordination between the program elements.
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Affiliation(s)
- Patricia D Soderlund
- Memory Keepers Medical Discovery Team, University of Minnesota Medical School, 624 East 1St St, Duluth, MN, 20155805, USA.
- Division of General Internal Medicine, David Geffen School of Medicine, University of California Los Angeles, National Clinician Scholars Program, 1100 Glendon Ave., Suite 900, Los Angeles, CA, 90024, USA.
| | - Erick H Cheung
- David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, University of California, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Resnick Neuropsychiatric Hospital, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Madonna P Cadiz
- Luskin School of Public Affairs, University of California Los Angeles, 337 Charles E Young Dr E, Los Angeles, CA, 90095, USA
| | - Hafifa Siddiq
- Charles R. Drew University College of Nursing, 1731 E. 120th St., Los Angeles, CA, 90059, USA
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles, 1100 Glendon Ave., Suite 900, Los Angeles, CA, 90024, USA
| | - Maria Yerstein
- Boston University School of Medicine, St. Elizabeth's Medical Center, 736 Cambridge St, Brighton, MA, 02135, USA
| | - Sae Lee
- Didi Hirsch Mental Health Services, 4760 S. Sepulveda Blvd, Culver City, CA. 90230, USA
| | - Kenneth Wells
- David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, University of California, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Resnick Neuropsychiatric Hospital, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
- Research Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Suite 17.369B, Los Angeles, CA, 90024, USA
- David Geffen School of Medicine, National Clinician Scholars Program, Division of General Internal Medicine and Health Services Research, 1100 Glendon Ave., Suite 900, Los Angeles, CA, 90024, USA
- Department of Mental Health, Veterans Affairs Greater Los Angeles HealthCare System, 11301 Wilshire Boulevard, Los Angeles, CA, 90073, USA
| | - MarySue V Heilemann
- School of Nursing, Factor Building, University of California Los Angeles, Box 6919, Los Angeles, CA, 90095, USA
- Division of General Internal Medicine, David Geffen School of Medicine, University of California Los Angeles, National Clinician Scholars Program, 1100 Glendon Ave., Suite 900, Los Angeles, CA, 90024, USA
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Accorsi TAD, De Amicis Lima K, Köhler KF, Cordioli E, Pedrotti CHS. Assessment of suicidal ideation via telemedicine: a case report and management suggestions. Int J Emerg Med 2023; 16:84. [PMID: 37953263 PMCID: PMC10641932 DOI: 10.1186/s12245-023-00557-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 10/26/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Nowadays, we find ourselves in very unexpected and challenging circumstances facing the COVID-19 pandemic. The impact of the new coronavirus pandemic probably affected everyone's mental health, and people with pre-existing mental disorders may have an aggravated disease condition, leading to a suicide attempt. Pandemic also increased the use of direct-to-consumer telemedicine (TM) exponentially, and consequently, it was expected that cases of attempted suicide could be evaluated remotely. Some TM centers have adapted safety protocols from psychiatric guidelines for managing these patients. However, there is a lack of evidence of the effectiveness of follow-up by TM for patients at high risk for suicide, and there is no consensus on what action should be taken vis-à-vis the patient who requests immediate help remotely. CASE PRESENTATION Here, we reported a case of a TM evaluation of a patient's suicidal ideation in a direct-to-consumer telemedicine emergency center, describing the conduct taken in the face of this situation. We also discuss the importance of planning the emergency telemedicine center for situations of risk of suicide. CONCLUSIONS Telemedicine centers should be prepared for direct consumer assessment of suicidal ideation. Current management suggestions include recognizing the risk profile through institutional training and software skills and immediate referral for face-to-face assessment, encouraging continuous monitoring until the admission and active recruitment of family members or closest friends.
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Affiliation(s)
- Tarso Augusto Duenhas Accorsi
- Hospital Israelita Albert Einstein, Secretaria da Unidade de Telemedicina, Av. Albert Einstein, 627. Bloco B, 2° Andar, Sao Paulo, 05652-900, Brazil.
| | - Karine De Amicis Lima
- Hospital Israelita Albert Einstein, Secretaria da Unidade de Telemedicina, Av. Albert Einstein, 627. Bloco B, 2° Andar, Sao Paulo, 05652-900, Brazil
| | - Karen Francine Köhler
- Hospital Israelita Albert Einstein, Secretaria da Unidade de Telemedicina, Av. Albert Einstein, 627. Bloco B, 2° Andar, Sao Paulo, 05652-900, Brazil
| | - Eduardo Cordioli
- Hospital Israelita Albert Einstein, Secretaria da Unidade de Telemedicina, Av. Albert Einstein, 627. Bloco B, 2° Andar, Sao Paulo, 05652-900, Brazil
| | - Carlos Henrique Sartorato Pedrotti
- Hospital Israelita Albert Einstein, Secretaria da Unidade de Telemedicina, Av. Albert Einstein, 627. Bloco B, 2° Andar, Sao Paulo, 05652-900, Brazil
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Jabr S, Mahamid F, Hinnawi Z, Bdier D. Enhancing healthcare providers' diagnostic and intervention skills to deal with suicidal patients at emergency departments in the Palestinian hospitals: a quasi experimental study. BMC Health Serv Res 2023; 23:1213. [PMID: 37932743 PMCID: PMC10629064 DOI: 10.1186/s12913-023-10256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Suicide cases in Palestine continue to record a remarkable annual increase, but we lack a comprehensive verified national data collection system of suicide and it is expected that real numbers of attempted/suicide in Palestine are higher because not all suicide or attempted suicide cases are reported. The purpose of this study was to test the effectiveness of a time-limited training intervention in enhancing healthcare providers' diagnostic and intervention skills to deal with suicidal patients who visit emergency departments in Palestinian hospitals. METHODS The sample consisted of 43 healthcare providers who work in public hospitals in the northern of the West Bank of Palestine, ranging from 25 to 56 years, involving 36 males and 7 females. A one-group quasi-experimental design was used, in which the experimental group received a training program to enhance healthcare providers' diagnostic and intervention skills to deal with suicidal ideations and attempts, the intervention lasted for 8 weeks, with 1 session per week. The performance of the experimental group was tested before and after the intervention. RESULTS Our findings revealed the effectiveness of the training intervention in enhancing participants' suicide assessment, diagnosis, and self-care skills. CONCLUSIONS These results suggest that a brief and carefully developed training intervention can potentially change healthcare providers' perceptions and behaviors toward suicide with a possible impact on clinical care therein.
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Affiliation(s)
- Samah Jabr
- Community Mental Health Center, Palestinian Ministry of Health, Ramallah, Palestine
| | - Fayez Mahamid
- Psychology and Counseling Dept, An-Najah National University, Nablus, Palestine.
| | - Zaynab Hinnawi
- Psychology and Counseling Dept, An-Najah National University, Nablus, Palestine
| | - Dana Bdier
- Psychology and Counseling Dept, An-Najah National University, Nablus, Palestine
- University of Milano-Bicocca, Milan, Italy
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Osilla KC, Meredith LS, Griffin BA, Martineau M, Hindmarch G, Watkins KE. Design of CLARO+ (Collaboration Leading to Addiction Treatment and Recovery from Other Stresses, Plus): A randomized trial of collaborative care to decrease overdose and suicide risk among patients with co-occurring disorders. Contemp Clin Trials 2023; 132:107294. [PMID: 37454728 PMCID: PMC10528487 DOI: 10.1016/j.cct.2023.107294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/14/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The United States is mired in two intertwined epidemics of death from suicide and overdose. Opioid use disorder (OUD) and mental illness contribute to both, and individuals with co-occurring disorders (CODs) are a complex population at high risk. Although universal prevention makes sense from a public health perspective, medical and behavioral health providers often lack the time to proactively address these issues with all patients. In this study, we build upon a parent study called Collaboration Leading to Addiction Treatment and Recovery from Other Stresses (CLARO), a model of collaborative care in which care coordinators deliver preventative measures to high-risk patients and coordinate care with the patients' care team, with the goal of increasing MOUD retention and decreasing risk of suicide and overdose. METHODS CLARO+ adds intervention components on overdose prevention, recognition, and response training; lethal means safety counseling; and an effort to mail compassionate messages called Caring Contacts. Both CLARO and CLARO+ have been implemented at 17 clinics in New Mexico and California, and this study seeks to determine the difference in effectiveness between the two versions of the intervention. This paper describes the design protocol for CLARO+. CONCLUSION CLARO+ is an innovative approach that aims to supplement existing collaborative care with additional suicide and overdose prevention strategies. CLINICALTRIALS gov: NCT04559893.
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Affiliation(s)
- Karen Chan Osilla
- Stanford University School of Medicine, 1070 Arastradero Road, Palo Alto, CA 94304-5590, United States.
| | - Lisa S Meredith
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
| | - Beth Ann Griffin
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, United States.
| | - Monique Martineau
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, United States.
| | - Grace Hindmarch
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
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12
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Cholerzyńska H, Zasada W, Kłosiewicz T, Konieczka P, Mazur M. The Burden of Alcohol-Related Emergency Department Visits in a Hospital of a Large European City. Healthcare (Basel) 2023; 11:healthcare11060786. [PMID: 36981443 PMCID: PMC10099728 DOI: 10.3390/healthcare11060786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/26/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Alcohol consumption contributes to the development of numerous diseases and is a big organizational burden on emergency departments (EDs). (2) We examined data on alcohol-related ED admissions in Poznan, Poland between 1 April 2019 and 31 March 2022. A total of 2290 patients' records were collected and analysed. The main goal was to determine the impact that these visits had on the functioning of the ED and the hospital. (3) The alcohol-related admission rate was significantly higher in males (78.95% vs. 21.05%), and the median blood alcohol concentration (BAC) level was 2.60 (1.78-3.38) ‱. Most of the visits took place at weekends and in the evening. Patients with higher BAC tended to stay longer in the ED, but had a lower chance of being admitted. A majority of patients required radiology and laboratory testing, 20.44% needed psychiatric examination, and 19.69% suffered trauma, mainly to the head. (4) Injuries and mental problems were the most common medical emergencies. This study presents trends in alcohol-related ED attendances, examines reasons for visits, and makes an attempt to assess overall burden on EDs.
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Affiliation(s)
- Hanna Cholerzyńska
- Students' Scientific Circle of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland
| | - Wiktoria Zasada
- Students' Scientific Circle of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland
| | - Tomasz Kłosiewicz
- Department of Medical Rescue, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland
| | - Patryk Konieczka
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland
| | - Mateusz Mazur
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland
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13
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Waliski A, Matthieu MM, Allison MK, Wilson MP, Skaggs EM, Adkins DA, Owen RR. Emergency Departments Treating Veterans for Suicide: Ensuring Quality Care for Veterans Outside of Department of Veterans Affairs Health Care Facilities. J Emerg Nurs 2023; 49:255-265. [PMID: 36653229 DOI: 10.1016/j.jen.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Veterans die by suicide at higher rates than nonveterans. Given that the emergency department is often the first point of entry to healthcare following a suicide attempt, it would be beneficial for community providers to have knowledge of the characteristics, medical issues, and effective treatments most often associated with those having served in the military to ensure guideline concordant and quality suicide care. This study aimed to identify assessment and referral practices of emergency departments at rural community hospitals related to care for suicidal veterans and explore the feasibility and acceptability of identifying veterans in need of postdischarge aftercare. METHODS This qualitative exploratory study involved content analysis of semistructured interviews. Ten emergency clinicians from 5 rural Arkansas counties with high suicide rates were interviewed about their experiences working with suicidal patients within the emergency department and perceptions of assessment, management, and referral practices. RESULTS Although most of the emergency departments had a process for assessing for suicide risk, emergency clinicians did not always feel confident in their knowledge of assessing and caring for suicidal patients. Military history was not included in assessment, treatment, or aftercare planning, nor were brief interventions such as safety planning or lethal means safety education provided. DISCUSSION Best practices for suicide assessment and management of veterans exist; however, challenges specific to the emergency department regarding staff training and engaging the community to effectively link at-risk veterans to needed care hinder implementation. Veteran-inclusive assessment and intervention practices could enhance the quality of care provided in community emergency departments.
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14
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Powsner S, Goebert D, Richmond JS, Takeshita J. Suicide Risk Assessment, Management, and Mitigation in the Emergency Setting. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:8-17. [PMID: 37205029 PMCID: PMC10172543 DOI: 10.1176/appi.focus.20220072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Suicide is a serious public health issue and is a leading cause of death worldwide. Suicidal ideation is a common presentation in emergency department (ED) settings, with many nuanced complications. Therefore, understanding screening, assessment, and mitigation is paramount to successful encounters with individuals presenting to emergency settings in psychiatric crises. Screening helps to identify the few people at risk within a large group. Assessment seeks to decide whether a specific individual is at significant risk. Mitigation aims to reduce the risk of suicide or of a serious attempt for a person at risk. These aims cannot be achieved with perfect reliability, but some approaches are more effective than others. Suicide screening specifics are important, even to individual practitioners, because a positive screen triggers assessment. Most practitioners understand assessment well: beginning with early psychiatric training, they are taught signs and symptoms suggesting that a patient might be at risk of suicide. Mitigating suicide risk is increasingly important to reduce the misery of ED boarding for patients awaiting psychiatric admission. For many patients, hospital admission is unnecessary if support, monitoring, and contingency plans are workable. For any individual patient, there may be a complicated mix of findings, risks, and interventions. Evidence-based screening and assessment tools are inadequate for the possible complexities, making care of individual patients dependent on good clinical assessment. The authors review the available evidence and offer experienced recommendations for challenges not yet thoroughly researched.
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Affiliation(s)
- Seth Powsner
- Department of Psychiatry and Department of Emergency Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut (Powsner); Department of Psychiatry, John A. Burns School of Medicine (Goebert, Takeshita), and Office of Public Health Studies (Goebert), University of Hawaii, Honolulu; Department of Psychiatry, Tufts University School of Medicine, Tufts University, Medford, Massachusetts, and Jamaica Plain Department of Veterans Affairs (VA) Medical Center, VA Boston Health Care System, Boston (Richmond); Department of Psychiatry, Queen's Medical Center, Honolulu (Goebert, Takeshita)
| | - Deborah Goebert
- Department of Psychiatry and Department of Emergency Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut (Powsner); Department of Psychiatry, John A. Burns School of Medicine (Goebert, Takeshita), and Office of Public Health Studies (Goebert), University of Hawaii, Honolulu; Department of Psychiatry, Tufts University School of Medicine, Tufts University, Medford, Massachusetts, and Jamaica Plain Department of Veterans Affairs (VA) Medical Center, VA Boston Health Care System, Boston (Richmond); Department of Psychiatry, Queen's Medical Center, Honolulu (Goebert, Takeshita)
| | - Janet S Richmond
- Department of Psychiatry and Department of Emergency Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut (Powsner); Department of Psychiatry, John A. Burns School of Medicine (Goebert, Takeshita), and Office of Public Health Studies (Goebert), University of Hawaii, Honolulu; Department of Psychiatry, Tufts University School of Medicine, Tufts University, Medford, Massachusetts, and Jamaica Plain Department of Veterans Affairs (VA) Medical Center, VA Boston Health Care System, Boston (Richmond); Department of Psychiatry, Queen's Medical Center, Honolulu (Goebert, Takeshita)
| | - Junji Takeshita
- Department of Psychiatry and Department of Emergency Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut (Powsner); Department of Psychiatry, John A. Burns School of Medicine (Goebert, Takeshita), and Office of Public Health Studies (Goebert), University of Hawaii, Honolulu; Department of Psychiatry, Tufts University School of Medicine, Tufts University, Medford, Massachusetts, and Jamaica Plain Department of Veterans Affairs (VA) Medical Center, VA Boston Health Care System, Boston (Richmond); Department of Psychiatry, Queen's Medical Center, Honolulu (Goebert, Takeshita)
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15
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The performance of machine learning models in predicting suicidal ideation, attempts, and deaths: A meta-analysis and systematic review. J Psychiatr Res 2022; 155:579-588. [PMID: 36206602 DOI: 10.1016/j.jpsychires.2022.09.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/21/2022] [Accepted: 09/24/2022] [Indexed: 11/21/2022]
Abstract
Research has posited that machine learning could improve suicide risk prediction models, which have traditionally performed poorly. This systematic review and meta-analysis evaluated the performance of machine learning models in predicting longitudinal outcomes of suicide-related outcomes of ideation, attempt, and death and examines outcome, data, and model types as potential covariates of model performance. Studies were extracted from PubMed, Web of Science, Embase, and PsycINFO. A bivariate mixed effects meta-analysis and meta-regression analyses were performed for studies using machine learning to predict future events of suicidal ideation, attempts, and/or deaths. Risk of bias was assessed for each study using an adaptation of the Prediction model Risk Of Bias Assessment Tool. Narrative review included 56 studies, and analyses examined 54 models from 35 studies. The models achieved a very good pooled AUC of 0.86, sensitivity of 0.66 (95% CI [0.60, 0.72)], and specificity of 0.87 (95% CI [0.84, 0.90]). Pooled AUCs for ideation, attempt, and death were similar at 0.88, 0.87, and 0.84 respectively. Model performance was highly varied; however, meta-regressions did not provide evidence that performance varied by outcome, data, or model types. Findings suggest that machine learning has the potential to improve suicide risk detection, with pooled estimates of machine learning performance comparing favourably to performance of traditional suicide prediction models. However, more studies with lower risk of bias are necessary to improve the application of machine learning in suicidology.
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16
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Anderson K, Goldsmith LP, Lomani J, Ali Z, Clarke G, Crowe C, Jarman H, Johnson S, McDaid D, Pariza P, Park AL, Smith JA, Stovold E, Turner K, Gillard S. Short-stay crisis units for mental health patients on crisis care pathways: systematic review and meta-analysis. BJPsych Open 2022; 8:e144. [PMID: 35876075 PMCID: PMC9344431 DOI: 10.1192/bjo.2022.534] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Internationally, an increasing proportion of emergency department visits are mental health related. Concurrently, psychiatric wards are often occupied above capacity. Healthcare providers have introduced short-stay, hospital-based crisis units offering a therapeutic space for stabilisation, assessment and appropriate referral. Research lags behind roll-out, and a review of the evidence is urgently needed to inform policy and further introduction of similar units. AIMS This systematic review aims to evaluate the effectiveness of short-stay, hospital-based mental health crisis units. METHOD We searched EMBASE, Medline, CINAHL and PsycINFO up to March 2021. All designs incorporating a control or comparison group were eligible for inclusion, and all effect estimates with a comparison group were extracted and combined meta-analytically where appropriate. We assessed study risk of bias with Risk of Bias in Non-Randomized Studies - of Interventions and Risk of Bias in Randomized Trials. RESULTS Data from twelve studies across six countries (Australia, Belgium, Canada, The Netherlands, UK and USA) and 67 505 participants were included. Data indicated that units delivered benefits on many outcomes. Units could reduce psychiatric holds (42% after intervention compared with 49.8% before intervention; difference = 7.8%; P < 0.0001) and increase out-patient follow-up care (χ2 = 37.42, d.f. = 1; P < 0.001). Meta-analysis indicated a significant reduction in length of emergency department stay (by 164.24 min; 95% CI -261.24 to -67.23 min; P < 0.001) and number of in-patient admissions (odds ratio 0.55, 95% CI 0.43-0.68; P < 0.001). CONCLUSIONS Short-stay mental health crisis units are effective for reducing emergency department wait times and in-patient admissions. Further research should investigate the impact of units on patient experience, and clinical and social outcomes.
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Affiliation(s)
- Katie Anderson
- Division of Nursing, School of Health Sciences, City, University of London, UK
| | - Lucy P Goldsmith
- Division of Nursing, School of Health Sciences, City, University of London, UK
| | - Jo Lomani
- Division of Nursing, School of Health Sciences, City, University of London, UK
| | - Zena Ali
- Library Services, St George's, University of London, UK
| | | | - Chloe Crowe
- Sunflowers Court, North East London NHS Foundation Trust, UK
| | - Heather Jarman
- Emergency Care, St George's University Hospitals NHS Foundation Trust, London; and Population Health Research Institute, St George's, University of London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, UK
| | - Paris Pariza
- Collabor8research, London, UK; and Division of Nursing, School of Health Sciences, City, University of London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, UK
| | - Jared A Smith
- Population Health Research Institute, St George's, University of London, UK
| | - Elizabeth Stovold
- Population Health Research Institute, St George's, University of London, UK
| | - Kati Turner
- Population Health Research Institute, St George's, University of London, UK
| | - Steve Gillard
- Division of Nursing, School of Health Sciences, City, University of London, UK
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17
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Keyes D, Talarico P, Hardin B, Molter A, Lee H, Valiuddin H, Moore B. Suicidal ideation and sobriety: Should acute alcohol intoxication be taken into account for psychiatric evaluation? Alcohol Clin Exp Res 2022; 46:1306-1312. [PMID: 35581530 DOI: 10.1111/acer.14871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND When evaluating an emergency department (ED) patient who presents with suicidal ideation, it is a common practice to wait until the patient's ethanol level is known or calculated to be less than 80 mg/dl to evaluate patient safety. We know of no study that establishes an association between the degree of alcohol intoxication based on a blood alcohol level (BAL) and reported suicidal ideation (SI) upon recovery. METHODS We conducted a retrospective review of patients evaluated in a Midwestern ED for the calendar year 2017. Cases were selected if they had a psychiatric social work consult and a blood alcohol level drawn while in the ED. Patients were selected on the same 2 days each week throughout the year to meet the sample size requirements of the study, resulting in 1084 cases for review. Chi-square analysis was used to evaluate the relationship between suicidal ideation and alcohol intoxication as defined by a BAL ≥80 mg/dl. RESULTS Among patients presenting with suicidal ideation and a concurrent BAL ≥80 mg/dl, 69% no longer reported suicidal ideation when their BAL was <80 mg/dl, compared to 38% for patients without a positive BAL on presentation (chi-square, p = 0.000012). CONCLUSION Our data show that patients presenting to the ED with complaints related to suicidal behavior who have a BAL ≥80 mg/dl are more likely to no longer endorse having suicidal ideation once their BAL is < 80 mg/dl than patients with similar presenting complaints and no alcohol intoxication. This finding supports the common ED practice of re-assessing suicidal ideation among individuals who are initially intoxicated once their BAL has decreased below 80 mg/dl.
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Affiliation(s)
- Daniel Keyes
- College of Osteopathic Medicine, Michigan State University, Lansing, Michigan, USA.,GME Research Department, Trinity Health Livonia Hospital, Livonia, Michigan, USA.,Departments of Emergency Medicine and Psychiatry, Trinity Health Livonia Hospital, Livonia, Michigan, USA.,Natural Sciences, College of Arts Sciences and Letters, University of Michigan-Dearborn, Dearborn, Michigan, USA
| | - Philip Talarico
- Meadville Medical Center, Mind Body Wellness Center, Meadville, Pennsylvania, USA
| | - Blake Hardin
- GME Research Department, Trinity Health Livonia Hospital, Livonia, Michigan, USA.,Natural Sciences, College of Arts Sciences and Letters, University of Michigan-Dearborn, Dearborn, Michigan, USA
| | - Alexander Molter
- GME Research Department, Trinity Health Livonia Hospital, Livonia, Michigan, USA
| | - Honesty Lee
- GME Research Department, Trinity Health Livonia Hospital, Livonia, Michigan, USA
| | - Hisham Valiuddin
- Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brandon Moore
- Departments of Emergency Medicine and Psychiatry, Trinity Health Livonia Hospital, Livonia, Michigan, USA
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18
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Lengvenyte A, Strumila R, Olié E, Courtet P. Ketamine and esketamine for crisis management in patients with depression: Why, whom, and how? Eur Neuropsychopharmacol 2022; 57:88-104. [PMID: 35219097 DOI: 10.1016/j.euroneuro.2022.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/13/2022]
Abstract
Currently, only a limited number of interventions can rapidly relieve depressive symptomatology in patients with major depressive disorder or bipolar disorder experiencing extreme distress. Such crises, especially when suicide attempt or ideation is involved, are a major risk factor of suicide. Ketamine, a N-methyl-d-aspartate glutamate receptor antagonist, and its enantiomer esketamine rapidly reduce depressive symptoms in depressed patients with current suicidal ideation. Recently, esketamine has been approved for use in patients with depression at risk of suicide and for psychiatric emergency by major medical agencies in the United States and Europe, whereas ketamine is increasingly used off-label. However, there is currently limited guidance on why, when, and how to use these drugs in patients with depression to treat a crisis. In this review article, we provide a succinct overview of the cellular and molecular mechanisms of action of ketamine and esketamine, and of the functional brain changes following their administration. We also summarize the major clinical studies on ketamine and esketamine efficacy in patients experiencing a crisis (generally, suicidal ideation), and propose a profile of patients who can benefit most from such drugs, on the basis of neurobiological and clinical observations. Finally, we describe the administration mode, the efficacy and tolerability profiles, the side effect management, possible concomitant treatments and the issue of deprescribing.
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Affiliation(s)
- Aiste Lengvenyte
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France; Psychiatric Clinic, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Robertas Strumila
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France; Psychiatric Clinic, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Emilie Olié
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
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19
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Virk F, Waine J, Berry C. A rapid review of emergency department interventions for children and young people presenting with suicidal ideation. BJPsych Open 2022; 8:e56. [PMID: 35241211 PMCID: PMC8935937 DOI: 10.1192/bjo.2022.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Suicidal ideation is an increasingly common presentation to the paediatric emergency department. The presence of suicidal ideation is linked to acute psychiatric hospital admission and increased risk of suicide. The paediatric emergency department plays a critical role in reducing risk of suicide, strengthening protective factors and encouraging patient engagement with ongoing care. AIMS This rapid review aims to synthesise evidence on interventions that can be implemented in the paediatric emergency department for children and adolescents presenting with suicidal ideation. METHOD Six electronic databases were searched for studies published since January 2010: PubMed, Web of Science, Medline, PsycINFO, CINAHL and Cochrane. Outcomes of interest included suicidal ideation, engagement with out-patient services, incidence of depressive symptoms, hopelessness, family empowerment, hospital admission and feasibility of interventions. The Cochrane risk-of-bias tool was used to evaluate the quality of studies. RESULTS Six studies of paediatric emergency department-initiated family-based (n = 4) and motivational interviewing interventions (n = 2) were narratively reviewed. The studies were mainly small and of varying quality. The evidence synthesis suggests that both types of intervention, when initiated by the paediatric emergency department, reduce suicidal ideation and improve patient engagement with out-patient services. Family-based interventions also showed a reduction in suicidality and improvement in family empowerment, hopelessness and depressive symptoms. CONCLUSIONS Paediatric emergency department-initiated interventions are crucial to reduce suicidal ideation and risk of suicide, and to enhance ongoing engagement with out-patient services. Further research is needed; however, family-based and motivational interviewing interventions could be feasibly and effectively implemented in the paediatric emergency department setting.
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Affiliation(s)
- Farazi Virk
- Brighton and Sussex Medical School, University of Sussex, UK
| | - Julie Waine
- Mental Health Liaison Team, Queen Alexandra Hospital, UK
| | - Clio Berry
- Brighton and Sussex Medical School, University of Sussex, UK
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20
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Mourad M, Kazour F, Sleilaty G, Bou Khalil R, El Hage W, Richa S, Sabbagh C. Positive and negative correlates of suicidal ideations and behaviors in the emergency department of a university hospital in Beirut: A cross-sectional comparative study. Encephale 2022; 49:248-253. [DOI: 10.1016/j.encep.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/04/2021] [Accepted: 11/23/2021] [Indexed: 11/26/2022]
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Romanelli M, Sheftall AH, Irsheid SB, Lindsey MA, Grogan TM. Factors Associated with Distinct Patterns of Suicidal Thoughts, Suicide Plans, and Suicide Attempts Among US Adolescents. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:73-84. [PMID: 34482517 PMCID: PMC8792183 DOI: 10.1007/s11121-021-01295-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 01/03/2023]
Abstract
The current study examined demographic, psychosocial, and substance use factors associated with distinct patterns of past 12-month suicide thoughts, plans, and attempts among adolescents drawn from a nationally representative sample of high schoolers. Data were from the 2015, 2017, and 2019 National Youth Risk Behavior Survey. Four mutually exclusive 12-month suicidal behavior patterns were identified: suicide thoughts only (pattern 1), suicide thoughts and plans without suicide attempt (pattern 2), suicide attempt with thoughts and/or plans (pattern 3), and suicide attempt without thoughts or plans (pattern 4). Multinomial logistic regression analyses were conducted to examine factors correlated with these distinct patterns. Psychosocial and substance use factors were modeled as independent predictors, controlling for demographic characteristics, as well as simultaneously to represent the potential for co-occurrence. The analytic sample included 7491 respondents. About 24% (n = 1734) of youth endorsed pattern 1, 38% (n = 2779) pattern 2, 35% (n = 2716) pattern 3, and 3% (n = 262) pattern 4. All psychosocial and substance use factors measured were individually associated with greater odds of suicide attempts with thoughts or plans (pattern 3) than patterns 1 or 2. Black and male youth were at greater odds of suicide attempts without thoughts or plans (pattern 4) than all other patterns. When modeled simultaneously, respondents who were bullied online, sad or hopeless, had a history of sexual violence, used cigarettes, and misused prescription opiates retained greater odds of suicide attempts with thoughts or plans (pattern 3) than patterns 1 or 2. Findings suggest screening for suicidal behaviors should include factors that differentiate between varying suicidal expressions and that may cue providers to intervene in the absence of suicide thoughts and plans.
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Affiliation(s)
- Meghan Romanelli
- School of Social Work, University of Washington, 4101 15th Avenue NE, WA, 98105-6250, Seattle, USA.
| | - Arielle H Sheftall
- Department of Pediatrics, Center for Suicide Prevention and Research, The Abigail Wexner Research Institute At Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sireen B Irsheid
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, USA
| | - Michael A Lindsey
- Silver School of Social Work, NYU McSilver Institute for Poverty Policy and Research, New York University, New York, NY, USA
| | - Tracy M Grogan
- NYU McSilver Institute for Poverty Policy and Research, New York, NY, USA
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22
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Shin HD, Cassidy C, Weeks LE, Campbell LA, Drake EK, Wong H, Donnelly L, Dorey R, Kang H, Curran JA. Interventions to change clinicians' behavior related to suicide-prevention care in the emergency department: a scoping review. JBI Evid Synth 2021; 20:788-846. [PMID: 34907133 DOI: 10.11124/jbies-21-00149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review was to explore, characterize, and map the literature on interventions and intervention components implemented to change emergency department clinicians' behavior related to suicide prevention using the Behaviour Change Wheel as a guiding theoretical framework. INTRODUCTION An emergency department is a critical place for suicide prevention, yet patients are often discharged without proper suicide risk assessments and/or referrals. In response, we must support emergency department clinicians' behavior change to follow evidence-based suicide prevention strategies. However, reviews to date have yet to systematically and theoretically examine interventions' functional characteristics and how they can influence emergency department clinicians' behaviors related to suicide-prevention care. INCLUSION CRITERIA This review considered interventions that targeted emergency department clinicians' behavior change related to suicide prevention. Behavior change referred to observable practice changes as well as proxy measures of behavior change, including changes in knowledge and attitude. METHODS This review followed JBI methodology for scoping reviews. Searches included PubMed, PsycINFO, CINAHL, Embase, and gray literature, including targeted Google searches for relevant organizations/websites, ProQuest Dissertations and Theses Global, and Scopus conference papers (using a specific filter). This review did not apply any date limits, but our search was limited to the English language. Data extraction was undertaken using a charting table developed specifically for the review objective. Narrative descriptions of interventions were coded using the Behavior Change Wheel's intervention functions. Reported outcome measures were categorized. Findings are tabulated and synthesized narratively. RESULTS Forty-one studies were included from the database searches, representing a mixture of experimental (n = 2), quasi-experimental (n = 24), non-experimental (n = 12), qualitative (n = 1), and mixed methods (n = 2) approaches. An additional 29 citations were included from gray literature searches. One was a pilot mixed methods study, and the rest were interventions. In summary, this review included a total of 70 citations, describing 66 different interventions. Identified interventions comprised a wide range of Behaviour Change Wheel intervention functions to change clinicians' behavior: education (n = 48), training (n = 40), enablement (n = 36), persuasion (n = 21), environmental restructuring (n = 18), modeling (n = 7), and incentivisation (n = 2). Based on the Behaviour Change Wheel analysis, many interventions targeted more than one determinant of behavior change, often employing education and training to improve clinicians' knowledge and skills simultaneously. Among the 42 studies that reported outcome measures, effectiveness was measured at clinician (n = 38), patient (n = 4), and/or organization levels (n = 6). Few studies reported implementation outcomes, such as measures of reach (n = 4), adoption (n = 5), or fidelity (n = 1). There were no evaluation data reported on the interventions identified through Google searches. CONCLUSIONS Interventions included in this review were diverse and leveraged a range of mechanisms to change emergency department clinicians' behavior. However, most interventions relied solely on education and/or training to improve clinicians' knowledge and/or skills. Future research should consider diverse intervention functions to target both individual- and/or organization-level barriers for a given context. Secondly, the ultimate goal for changing emergency department clinicians' behavior is to improve patient health outcomes related to suicide-related thoughts and behaviors, but current research has most commonly evaluated clinicians' behavior in isolation of patient outcomes. Future studies should consider reporting patient-level outcomes alongside clinician-level outcomes.
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Affiliation(s)
- Hwayeon Danielle Shin
- School of Nursing, Dalhousie University, Halifax, NS, Canada Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada Faculty of Health, Dalhousie University, Halifax, NS, Canada Nova Scotia Health Authority, Halifax, NS, Canada
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Olfson M, Gao YN, Xie M, Wiesel Cullen S, Marcus SC. Suicide Risk Among Adults With Mental Health Emergency Department Visits With and Without Suicidal Symptoms. J Clin Psychiatry 2021; 82:20m13833. [PMID: 34705348 PMCID: PMC8672323 DOI: 10.4088/jcp.20m13833] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: To describe risk factors and suicide rates during the year following discharge from mental health emergency department (ED) visits by adults with suicide attempts, suicidal ideation, or neither. Methods: National cohorts of patients with mental health ED visits for suicide attempts or self-harm (n = 55,323), suicidal ideation (n = 435,464), or other mental health visits (n = 9,144,807) from 2008 to 2012 Medicaid data were followed for suicide for 1 year after discharge. Suicide rates per 100,000 person-years were determined from National Death Index data. Poisson regression models, adjusted for age, sex, and race/ethnicity, estimated suicide rate ratios (RRs). Suicide standardized mortality ratios (SMRs) were estimated from National Vital Statistics System data. Results: Suicide rates per 100,000 person-years were 325.4 for suicide attempt or self-harm visits (RR = 5.51, 95% CI, 4.64-6.55), 156.6 for suicidal ideation visits (RR = 2.59, 95% CI, 2.34-2.87), and 57.0 for the other mental health ED visits (1.0, reference). Compared to expected suicide general population rates, SMRs were 18.2 (95% CI, 13.0-23.4) for suicide attempt or self-harm patients, 10.6 (95% CI, 9.0-12.2) for suicidal ideation patients, and 3.2 (95% CI, 3.1-3.4) for other ED mental health patients. Among patients with suicide attempt ED visits in the 180 days before their index mental health ED visit, suicide rates per 100,000 person-years were 687.2 (95% CI, 396.5-978.0) for attempt or self-harm visits, 397.4 (95% CI, 230.6-564.3) for ideation visits, and 328.4 (95% CI, 241.5-415.4) for other mental health visits. Conclusions: In the year following discharge, emergency department patients with suicide attempts or self-harm, especially repeated attempts, have a high risk of suicide.
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, New York.,Corresponding author: Mark Olfson, MD, MPH, New York State Psychiatric Institute/Department of Psychiatry, Vagelos College of Physicians and Surgeons of Columbia University, 1051 Riverside Dr, New York, NY 10032
| | - Y. Nina Gao
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, NY
| | - Ming Xie
- University of Pennsylvania, School of Social Policy & Practice, Philadelphia, PA
| | - Sara Wiesel Cullen
- University of Pennsylvania, School of Social Policy & Practice, Philadelphia, PA
| | - Steven C Marcus
- University of Pennsylvania, School of Social Policy & Practice, Philadelphia, PA
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K R, Ananda Rao A, D K, Vaishnav PP, Davis S, T A, J DK, Suresh A, Nadig C. Patients With Suicidal Patterns in the Emergency Room: A Clinical and Social Reflection. Cureus 2021; 13:e18570. [PMID: 34765347 PMCID: PMC8575329 DOI: 10.7759/cureus.18570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/27/2022] Open
Abstract
Background and objective Emergency physicians come across a myriad of medical afflictions resulting from suicide attempts. The Indian contribution to global suicide deaths is alarming; the social construct of India is unique, and so are the problems and challenges. This study aims to describe the social background, demographic parameters and correlate the clinical profile and outcomes of all patients presenting with an attempted or completed suicide. Materials and methods The present study is a hospital-based prospective observational study conducted by the Department of Emergency Medicine at RL Jalappa Hospital and Research Centre, a rural tertiary-care center in Karnataka, India, from June 2020 to February 2021. After stabilizing the patient, a detailed socio-demographic history was recorded. Details of the suicide attempt and findings of the clinical examination were noted. Results The final study sample consisted of 89 patients who presented to the emergency room (ER). Fifty-three patients were female, and thirty-six were males; the average age of the sample was 28.4 ± 11 years. A higher proportion of men who completed pre-university education (p= 0.0005, c2= 11.98) or had a graduate degree (p= 0.009, c2= 6.71) attempted suicide. Amongst all women who attempted suicide, 73.6% (n=39) were married at the time of the event (p= 0.0006, c2= 11.79). Poisoning (n=59) was the most common method of attempting suicide. We also observed that it was primarily men who attempted suicide when under the influence of alcohol (p= 0.006, c2= 7.57). The most common reason for attempting suicide was familial disharmony, including domestic violence. A Glasgow Coma Scale (GCS) score of 9/15 and less at the time of presentation resulted in a mortality rate of 28.6%, whereas patients with a GCS score of 10 and above had a mortality rate of 6.1% (p= 0.04, c2= 4.14). Discussion Marriage appears to be less protective for Indian women than Indian men. Poisoning was the most common method of attempted suicide in our study, followed by tablet overdose. The reason for the above could be ease of access to household poisons. Insecticides have been a preferred method in the Indian population over the years. Aluminum phosphide poisoning, a common constituent of rodenticides, is associated with a high mortality rate. However, in the West, firearm-related incidents have the highest mortality. Multiple correspondence analysis (MCA) of the National Crime Records Bureau (NCRB), India, data showed that adult males succumb majorly to romantic relations, unemployment, and failure in examinations. The use of alcohol was more in the illiterate and unskilled workers; however, high school educated persons and students used alcohol intentionally to facilitate suicide. Lower Glasgow Coma Scale values are associated with higher fatality; however, some studies found that Full Outline of Unresponsiveness (FOUR) and Acute Physiology and Chronic Health Evaluation Score (APACHE) II scores are better mortality indicators. Conclusion Besides the presentation and GCS score, cognizance of the lethality of different methods in attempting suicide provides clues in anticipating the patient's clinical course. The social patterns of suicide must be considered while designing awareness campaigns and focused outreach programs to decrease suicides. A strict policy must be made and enforced to limit the availability of household poisons.
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Affiliation(s)
- Rajesh K
- Emergency Medicine, Sri Devaraj Urs Medical College and Research Hospital, Kolar, IND
| | - Amogh Ananda Rao
- Internal Medicine, Jagadguru Jayadeva Murugarajendra (JJM) Medical College, Davangere, IND
| | - Krishna D
- Emergency Medicine, Sri Devaraj Urs Medical College and Research Hospital, Kolar, IND
| | - Pratyaksh P Vaishnav
- Internal Medicine, Jagadguru Jayadeva Murugarajendra (JJM) Medical College, Davangere, IND
| | - Sissmol Davis
- Internal Medicine, Jagadguru Jayadeva Murugarajendra (JJM) Medical College, Davangere, IND
| | - Abhinov T
- Emergency Medicine, Sri Devaraj Urs Medical College and Research Hospital, Kolar, IND
| | - Devendraprasad K J
- Emergency Medicine, Sri Devaraj Urs Medical College and Research Hospital, Kolar, IND
| | - Ashutosh Suresh
- Internal Medicine, Jagadguru Jayadeva Murugarajendra (JJM) Medical College, Davangere, IND
| | - Chiranth Nadig
- Internal Medicine, Jagadguru Jayadeva Murugarajendra (JJM) Medical College, Davangere, IND
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Wilson MP, Kaur J, Blake L, Oliveto AH, Thompson RG, Pyne JM, Wolf L, Walker AP, Waliski AD, Nordstrom K. Adherence to guideline creation recommendations for suicide prevention in the emergency department: A systematic review. Am J Emerg Med 2021; 50:553-560. [PMID: 34547697 DOI: 10.1016/j.ajem.2021.07.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/21/2021] [Accepted: 07/20/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Suicide rates in the United States rose 35.2% from 1999-2018. As emergency department (ED) providers often have limited training in management of suicidal patients and minimal access to mental health experts, clinical practice guidelines (CPGs) may improve care for these patients. However, clinical practice guidelines that do not adhere to quality standards for development may be harmful both to patients, if they promote practices based on flawed evidence, and to ED providers, if used in malpractice claims. In 2011, the Institute of Medicine created standards to determine the trustworthiness of CPGs. This review assessed the adherence of suicide prevention CPGs, intended for the ED, to these standards. Secondary objectives were to assess the association of adherence both with first author/organization specialty (ED vs non-ED) and with inclusion of recommendations on substance use, a potent risk factor for suicide. METHODS This is a systematic review of available suicide-prevention CPGs for the ED in both peer-reviewed and gray literature. This review followed the PRISMA standards for reporting systematic reviews. RESULTS Of 22 included CPGs, the 7 ED-sponsored CPGs had higher adherence to quality standards (3.1 vs 2.4) and included the highest-rated CPG (ICAR2E) identified by this review. Regardless of specialty, nearly all CPGs included some mention of identifying or managing substance use. CONCLUSIONS Most suicide prevention CPGs intended for the ED are written by non-ED first authors or organizations and have low adherence to quality standards. Future CPGs should be developed with more scientific rigor, include a multidisciplinary writing group, and be created by authors working in the practice environment to which the CPG applies.
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Affiliation(s)
- Michael P Wilson
- Division of Research and Evidence-Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
| | - Jaskiran Kaur
- Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Lindsay Blake
- Academic Affairs, UAMS Library, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Alison H Oliveto
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Ronald G Thompson
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Jeffrey M Pyne
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Lisa Wolf
- Emergency Nurses Association, Schaumburg, Illinois
| | - A Paige Walker
- Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Angela D Waliski
- Department of Health Services Research and Development, Central Arkansas Veteran's Healthcare System, Little Rock, AR, United States of America
| | - Kimberly Nordstrom
- Department of Emergency Medicine Behavioral Emergencies Research Lab, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States of America
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Laliberte AZ, Roth B, Edwards B, Chen JI. Suicide Screening and Risk Assessment in the Emergency Department: Case Review of a Suicide Attempt Survivor. J Emerg Nurs 2021; 47:846-851. [PMID: 34479740 DOI: 10.1016/j.jen.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/17/2021] [Accepted: 07/23/2021] [Indexed: 11/25/2022]
Abstract
One in 10 of those who die by suicide are seen in an emergency department within the 2 months before their death. Despite national guidelines and resources (including from the Joint Commission and Emergency Nurses Association) for suicide screening, risk assessment, and follow-up care, suicidal ideation and behavior continue to go undetected in emergency departments, leading to gaps in care. This case review was conducted as part of a larger electronic medical record review of emergency department practices and aims to highlight potential gaps in care and identify missed opportunities for suicide screening and risk assessment. In addition to highlighting these missed opportunities, this case review provides recommendations for suicide screening and risk assessment resources with options for evidence-based follow-up care for suicidal patients.
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Brodeur J, Ley AF, Bonnet M. A survey of Midwest physicians' experiences with patients in psychiatric distress in the emergency department. J Osteopath Med 2021; 121:773-778. [PMID: 34315193 DOI: 10.1515/jom-2021-0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/08/2021] [Indexed: 11/15/2022]
Abstract
CONTEXT Emergency medicine (EM) physicians commonly stabilize patients with acute psychiatric distress, such as suicidal ideation. Research has shown that suicidal ideation is difficult to manage in emergency department (ED) settings and that patients in psychiatric distress are often "boarded" in the ED while awaiting more definitive care. OBJECTIVES To examine the attitudes and experiences of emergency physicians regarding the care of patients in psychiatric distress. Special attention is given to suicidal ideation due to its prevalence in the United States. METHODS A 19 question anonymous survey was sent via email to 55 emergency medicine residency directors throughout Michigan, Ohio, Indiana, and Illinois, who were identified using an Internet search of residency programs in the region. The program directors were asked to distribute the survey to their colleagues and residents. The intent of this procedure was to generate as many survey responses as possible, while obscuring the identities of the respondents. Responses were gathered from October 29, 2019 until January 16, 2020. The survey was designed to assess respondents' self-reported demographic data as well as their experiences with the boarding process, initial examination, final disposition, reevaluation of the patient, physician training and resources, and follow up care. Statistical analysis was performed using a Mann-Whitney U test, significance was set at p<0.01. RESULTS In total, 47 EM physicians responded to the survey; however, not all of the respondents completed all 19 questions. Ten of 44 respondents (22.7%) reported that they do not perform the initial psychiatric examination themselves and instead defer to a nurse or social worker. Twenty-two of 44 respondents (50.0%) reported that they defer to a social worker when determining the final disposition of psychiatric patients. Respondents reevaluated patients in psychiatric distress statistically significantly less often (p=0.01) compared with patients with cardiac pathology. Additionally, 15 of 38 respondents (39.5%) reported that they did not feel adequately trained to handle psychiatric emergencies, and 36 of 39 respondents (92.3%) of physicians felt that their facility would benefit from additional mental health resources. Thirty five of 39 respondents (89.7%) reported that their facility did not have a system in place to follow up with suicidal patients upon discharge. CONCLUSIONS Caring for patients who are acutely suicidal or in psychiatric distress is complex and more research is needed to optimize treatment strategies. The results of this study indicate that EM physicians may regularly defer to nonphysician providers when evaluating and treating patients in psychiatric distress. A perceived lack of training in psychiatry may contribute to this practice. The results of this study are in accord with previous research that indicated a need for additional psychiatry training in EM residencies.
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Affiliation(s)
- Jack Brodeur
- Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA
| | - Alyse Folino Ley
- Psychiatry Residency Program, Department of Psychiatry, Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA.,Child and Adolescent Psychiatry Fellowship, Department of Psychiatry, Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA
| | - Michelle Bonnet
- PGY IV, Psychiatry Residency Program, Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA
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Troya MI, Cully G, Leahy D, Cassidy E, Sadath A, Nicholson S, Ramos Costa AP, Alberdi-Páramo Í, Jeffers A, Shiely F, Arensman E. Investigating the relationship between childhood sexual abuse, self-harm repetition and suicidal intent: mixed-methods study. BJPsych Open 2021; 7:e125. [PMID: 34236021 PMCID: PMC8281309 DOI: 10.1192/bjo.2021.962] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Research into the association between childhood sexual abuse (CSA) and self-harm repetition is limited. AIMS We aimed to examine the association between self-harm repetition, mental health conditions, suicidal intent and CSA experiences among people who frequently self-harm. METHOD A mixed-methods study was conducted including consecutive patients aged ≥18 years, with five or more self-harm presentations, in three Irish hospitals. Information was extracted from psychiatric records and patients were invited to participate in a semi-structured interview. Data was collected and analysed with a mixed-methods, convergent parallel design. In tandem, the association between CSA and self-harm repetition, suicidal intent and mental health conditions was examined with logistic regression models and independent sample t-test, with psychiatric records data. Thematic analysis was conducted with interview data, to explore CSA experiences and self-harm repetition. RESULTS Between March 2016 and July 2019, information was obtained on 188 consecutive participants, with 36 participants completing an interview. CSA was recorded in 42% of the total sample and 72.2% of those interviewed. CSA was positively associated with self-harm repetition (odds ratio 6.26, 95% CI 3.94-9.94, P = 0.00). Three themes emerged when exploring participants' CSA experiences: CSA as a precipitating factor for self-harm, secrecy of CSA accentuating shame, and loss experiences linked to CSA and self-harm. CONCLUSIONS CSA was frequently reported among people who frequently self-harm, and associated with self-harm repetition. Identification of patients at risk of repetition is key for suicide prevention. This is an at-risk group with particular characteristics that must be considered; comprehensive patient histories can help inform and tailor treatment pathways.
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Affiliation(s)
- Maria Isabela Troya
- School of Public Health, College of Medicine and Health, University College Cork, Ireland; and National Suicide Research Foundation, University College Cork, Ireland
| | - Grace Cully
- School of Public Health, College of Medicine and Health, University College Cork, Ireland; and National Suicide Research Foundation, University College Cork, Ireland
| | - Dorothy Leahy
- School of Public Health, College of Medicine and Health, University College Cork, Ireland; and National Suicide Research Foundation, University College Cork, Ireland
| | - Eugene Cassidy
- Cork University Hospital Group, Liaison Psychiatry Service, Ireland
| | - Anvar Sadath
- School of Public Health, College of Medicine and Health, University College Cork, Ireland; and National Suicide Research Foundation, University College Cork, Ireland
| | - Sarah Nicholson
- School of Public Health, College of Medicine and Health, University College Cork, Ireland; and National Suicide Research Foundation, University College Cork, Ireland
| | - Ana Paula Ramos Costa
- School of Public Health, College of Medicine and Health, University College Cork, Ireland; and National Suicide Research Foundation, University College Cork, Ireland
| | - Íñigo Alberdi-Páramo
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Spain; and Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, Spain
| | - Anne Jeffers
- National Clinical Programme for the Assessment and Management of Patients presenting to the Emergency Department following Self-Harm, Office of the National Clinical Advisor and Group Lead - Mental Health, Dr. Steeven's Hospital, Ireland
| | - Frances Shiely
- School of Public Health, College of Medicine and Health, University College Cork, Ireland
| | - Ella Arensman
- School of Public Health, College of Medicine and Health, University College Cork, Ireland; National Suicide Research Foundation, University College Cork, Ireland; and Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Australia
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Treating Pediatric and Geriatric Patients at Risk of Suicide in General Emergency Departments: Perspectives From Emergency Department Clinical Leaders. Ann Emerg Med 2021; 78:628-636. [PMID: 34218952 DOI: 10.1016/j.annemergmed.2021.04.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/01/2021] [Accepted: 04/16/2021] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE We explored emergency department clinical leaders' views on providing emergency mental health services to pediatric and geriatric patients with suicidal ideation and suicide attempts. METHODS We conducted semistructured interviews with a total of 34 nursing directors, medical directors, and behavioral health managers at 17 general hospital EDs across the United States, using purposive sampling to ensure variation among hospitals. Interviews were audio-recorded, transcribed verbatim, and coded and analyzed using Atlas.ti and a directed content analysis approach. RESULTS Respondents from across a range of ED types expressed concerns regarding the capacity of their EDs to meet mental health needs of children and older adults. They experienced emotional distress over the increasing number of pediatric patients presenting to EDs with suicidal ideation/suicide attempt and described EDs as inappropriate environments for young patients with suicidal ideation/suicide attempt. Similarly, leaders expressed feeling ill-equipped to diagnose and treat geriatric patients with suicidal ideation/suicide attempt, who often had medical comorbidities that complicated treatment planning. Respondents noted that pediatric and geriatric patients frequently boarded in the ED. Some felt compelled to use creative solutions to provide safe spaces for pediatric and geriatric patients. Respondents voiced frustration over the lack of outpatient and inpatient mental health services for these patients. CONCLUSION Clinical leaders in EDs across the nation expressed distress at feeling they were not adequately equipped to meet the needs of pediatric and geriatric patients with suicidal ideation/suicide attempt. Future innovations to provide ED care for children and older adults with suicidal ideation/suicide attempt might include training for ED teams, access to specialist mental health clinicians through telehealth, and adaptations of physical spaces.
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Shirzad F, Gholamzad S, Shafiee M, Shariat SV. Development of a pre-hospital emergencies protocol for the management of suicidal patients in Iran. BMC Emerg Med 2021; 21:47. [PMID: 33853531 PMCID: PMC8048184 DOI: 10.1186/s12873-021-00437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background Suicide is a painful consequence of many psychiatric disorders and one of the most frequent psychiatric emergencies. Generally, pre-hospital technician is the first person in the treatment chain who attends the situation; hence, his/her sound clinical judgment and professional behavior can play an important role in preventing or stopping the suicide process. We tried to develop a concise, evidence-based, and step-by-step guide for dealing with a suicidal patient, which could be quickly reviewed by technicians before confronting a suicide situation. Method We reviewed the literature for suicide management plans and protocols, to extract the evidence-based interventions and instructions for dealing with a suicide situation. Then, we discussed the extracted material in an expert panel, and developed the initial version of the protocol considering the local socio-cultural issues and available facilities. Subsequently, we reviewed the protocol in a meeting with pre-hospital technicians and emergency physicians, to receive their feedback and address any possible executive problems. Finally, we revised the protocol to its final version considering the feedbacks. Results The basic principles of dealing with a suicidal patient are similar to other psychiatric emergencies and include: Patient Safety; Patient evaluation and diagnosis; and Patient (behavioral and pharmacological) management. However, specific considerations should be taken into account and special arrangements are necessary for suicidal patients. Whether the patient has attempted suicide or not, would guide the management to one of the two major paths. In addition, the needs of the family should be considered. Conclusion A locally adapted protocol considering existing facilities in the emergency system and cultural issues in Iranian society is provided for pre-hospital emergency technicians.
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Affiliation(s)
- Fatemeh Shirzad
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shakiba Gholamzad
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Maisam Shafiee
- Department of Clinical Psychology, School of Behavioral Science and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Science, Tehran, Iran
| | - Seyed Vahid Shariat
- Mental Health Research Center, Psychological Health research institute (PHRI), Iran University of Medical Science, Tehran, Iran. .,School of Behavioral Science and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Science, Tehran, Iran.
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Baker D, Blyth D, Stedman T, Meehan T. Case manager perceptions of emergency department use by patients with non-fatal suicidal behaviour. Int J Ment Health Nurs 2021; 30:487-494. [PMID: 33159377 DOI: 10.1111/inm.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 11/30/2022]
Abstract
Repeat presentations to the emergency department (ED) for non-fatal suicidal behaviour (NFSB) are common in Australia and overseas. The challenges faced by mental health services in managing this sub-group of patients have not been fully explored. In this qualitative study, we consider how case managers view frequent ED use by patients with NFSB. Individual interviews with case managers were audio-recorded, transcribed verbatim, and subjected to thematic analysis. Four main themes emerged: a logical place to go; not a lot of benefit from an ED visit; focus on managing risk; and building a life outside of the ED. The case managers noted that patients with NFSB tend to have complex presentations that are challenging to address in the ED. The focus tends to be on assessment of risk with referral to community support agencies. The findings point to the need to identify more intensive care options that support patients to reduce their dependency on the ED. Insights gleaned from the study have implications for those working with NFSB patients.
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Affiliation(s)
- Debra Baker
- West Moreton Hospital and Health Service, Ipswich, Queensland, Australia
| | - Deborah Blyth
- West Moreton Hospital and Health Service, Ipswich, Queensland, Australia
| | - Terry Stedman
- West Moreton Hospital and Health Service, Ipswich, Queensland, Australia.,Department of Psychiatry, University of Queensland, Brisbane, Queensland, Australia
| | - Tom Meehan
- West Moreton Hospital and Health Service, Ipswich, Queensland, Australia.,Department of Psychiatry, University of Queensland, Brisbane, Queensland, Australia
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Dimeff LA, Jobes DA, Koerner K, Kako N, Jerome T, Kelley-Brimer A, Boudreaux ED, Beadnell B, Goering P, Witterholt S, Melin G, Samike V, Schak KM. Using a Tablet-Based App to Deliver Evidence-Based Practices for Suicidal Patients in the Emergency Department: Pilot Randomized Controlled Trial. JMIR Ment Health 2021; 8:e23022. [PMID: 33646129 PMCID: PMC7961404 DOI: 10.2196/23022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/11/2020] [Accepted: 12/18/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Emergency departments (EDs) have the potential to provide evidence-based practices for suicide prevention to patients who are acutely suicidal. However, few EDs have adequate time and personnel resources to deliver recommended evidence-based assessment and interventions. To raise the clinical standard of care for patients who are suicidal and seeking psychiatric crisis services in the ED, we developed Jaspr Health, a tablet-based app for direct use by such patients, which enables the delivery of 4 evidence-based practices. OBJECTIVE This study aims to evaluate the feasibility, acceptability, and effectiveness of Jaspr Health among suicidal adults in EDs. METHODS Patients who were acutely suicidal and seeking psychiatric crisis services participated in an unblinded pilot randomized controlled trial while in the ED. Participants were randomly assigned to Jaspr Health (n=14) or care as usual (control; n=17) groups. Participants were assessed at baseline, and a 2-hour posttest using self-report measures and a semistructured interview were conducted. RESULTS Conditions differed significantly at baseline with regard to age but not other demographic variables or baseline measures. On average, participants had been in the ED for 17 hours before enrolling in the study. Over their lifetime, 84% (26/31) of the sample had made a suicide attempt (mean 3.4, SD 6.4) and 61% (19/31) had engaged in nonsuicidal self-injurious behaviors, with an average rate of 8.8 times in the past 3 months. All established feasibility and acceptability criteria were met: no adverse events occurred, participants' app use was high, Jaspr Health app user satisfaction ratings were high, and all participants using Jaspr Health recommended its use for other suicidal ED patients. Comparisons between study conditions provide preliminary support for the effectiveness of the app: participants using Jaspr Health reported a statistically significant increase in receiving 4 evidence-based suicide prevention interventions and overall satisfaction ratings with their ED experience. In addition, significant decreases in distress and agitation, along with significant increases in learning to cope more effectively with current and future suicidal thoughts, were observed among participants using Jaspr Health compared with those receiving care as usual. CONCLUSIONS Even with limited statistical power, the results showed that Jaspr Health is feasible, acceptable, and clinically effective for use by ED patients who are acutely suicidal and seeking ED-based psychiatric crisis services. TRIAL REGISTRATION ClinicalTrials.gov NCT03584386; https://clinicaltrials.gov/ct2/show/NCT03584386.
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Affiliation(s)
- Linda A Dimeff
- Evidence Based Practice Institute, Inc, Seattle, WA, United States
| | - David A Jobes
- The Catholic University of America, Washington, DC, United States
| | - Kelly Koerner
- Evidence Based Practice Institute, Inc, Seattle, WA, United States
| | - Nadia Kako
- Evidence Based Practice Institute, Inc, Seattle, WA, United States
| | - Topher Jerome
- Evidence Based Practice Institute, Inc, Seattle, WA, United States
| | | | - Edwin D Boudreaux
- Department of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | | | - Paul Goering
- Mental Health and Addiction, Allina Health, Minneapolis, MN, United States
| | - Suzanne Witterholt
- Mental Health and Addiction, Allina Health, Minneapolis, MN, United States
| | - Gabrielle Melin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Vicki Samike
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Kathryn M Schak
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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Overall B, Hon SL, Jones A, Moran TP, Hunt K. Intentional suspected suicide exposures by poisoning among adolescents from 2009 to 2018 reported to the Georgia Poison Center and compared nationally. Basic Clin Pharmacol Toxicol 2021; 128:699-708. [PMID: 33523586 DOI: 10.1111/bcpt.13563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 11/30/2022]
Abstract
This retrospective chart review aimed to report the incidence and characteristics of intentional suspected suicide among 13- to 19-year-olds reported to the Georgia Poison Center (GPC) and compared nationally from 2009 to 2018. Of the 19 733 cases reported to the GPC, 74.9% were females. The total number of cases more than doubled from 2009 to 2018, increasing annually by 10%. Majority (90.1%) of the cases occurred in the home, and 60.4% of the cases resulted in either no effect or minor effect. More than half (66.5%) of the cases involved only one substance. Pharmaceuticals made up 94.5% of the substances used, with analgesics accounting for 42.10% and antidepressants at 20.77%. A significant difference was found in substances used between males and females (P < .001). Females were more likely to use analgesics (45.17% vs 32.90%), and males were more likely to use sedatives/hypnotics/antipsychotics (20.45% vs 13.58%). While the majority of the GPC patients were females, the GPC was more likely to have fewer female patients (74.7% vs 75.7%) and more male patients (25.3% vs 24.3%) than other poison centers. Intentional suspected suicide exposures by poisoning are on the rise and higher among females, demonstrating a need for strengthened intervention and prevention strategies.
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Affiliation(s)
| | | | | | - Tim P Moran
- Department of Emergency Medicine, Emory University, Atlanta, GA, USA
| | - Kevin Hunt
- Georgia College & State University, Milledgeville, GA, USA
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Kanzaria HK. Leveraging Cross-Sector Data to Address Social Needs in the Emergency Department. Ann Emerg Med 2020; 76:468-469. [DOI: 10.1016/j.annemergmed.2020.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Indexed: 11/16/2022]
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Shin HD, Price S, Aston M. A poststructural analysis: Current practices for suicide prevention by nurses in the emergency department and areas of improvement. J Clin Nurs 2020; 30:287-297. [PMID: 32956549 DOI: 10.1111/jocn.15502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/07/2020] [Accepted: 09/06/2020] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To use a poststructuralist framework to critique historical, social and institutional constructions of emergency nursing and examine conflicting discourses surrounding suicide prevention. The aim is to also demonstrate practical guidance for enhancing emergency nursing practice and research with regard to suicide prevention. BACKGROUND Emergency departments have been historically constructed as places for treating life-threatening physical crises, thereby constructing other "nonurgent" health needs as less of a priority. Physical needs take priority over psychological needs, such as suicide-related thoughts and behaviours, negatively impacting the quality of care that certain groups of patients receive. DESIGN A theoretical analysis of the published literature on the topic of emergency nursing and suicide prevention was conducted and analysed using a poststructuralist framework. METHODS Relevant literature on the topic of emergency nursing related to suicide prevention was analysed for a poststructuralist construct of power, language, subjectivity and discourse. Implications to practice and research were identified, as well as expanding emergency nursing using a poststructuralist framework. SQUIRE guidelines were used (see Supporting Information). DISCUSSION The emergency department is a critical point of intervention for patients with urgent and life-threatening needs. However, the biomedical model and historical, social, and institutional expectations that influence emergency nurses' beliefs and values do not effectively respond to the needs of suicidal patients. One step to address this issue is to deconstruct the current understanding of emergency nursing as a treatment for only life-threatening physical crises in order to become inclusive of psychological crises such as suicide-related thoughts and behaviours. RELEVANCE TO CLINICAL PRACTICE How a poststructural framework can be used to expand emergency care is discussed. Examples include empowering nurses to challenge the "taken-for-granted" emergency nursing and recognizing the health needs that fall outside of the dominant discourse of emergency care.
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Affiliation(s)
| | - Sheri Price
- Dalhousie University School of Nursing, Halifax, NS, Canada.,IWK Health Centre, Halifax, NS, Canada
| | - Megan Aston
- Dalhousie University School of Nursing, Halifax, NS, Canada.,IWK Health Centre, Halifax, NS, Canada
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Son JM, Jeong J, Ro YS, Hong W, Hong KJ, Song KJ, Do Shin S. Effect of previous emergency psychiatric consultation on suicide re-attempts - A multi-center observational study. Am J Emerg Med 2020; 38:1743-1747. [PMID: 32738470 DOI: 10.1016/j.ajem.2020.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The emergency department (ED) is one of the first gateways when suicide attempt patients seek health care services. The purpose of this study was to analyze the hypothesis that people who received emergency psychiatric services in previous suicide attempts will have a lower mortality rate in current ED visits owing to subsequent suicide attempts. METHOD This retrospective study included patients who visited six EDs, and participated in the injury surveillance and in-depth suicide surveillance for 10 years, from January 2008 to December 2017. The study subjects were adult patients 18 years or older who visited EDs due to suicide attempts. The main explanatory variable is whether psychiatric treatment was provided in previous suicide attempts. The main outcome variable was suicide related mortality. RESULTS The study included 2144 suicide attempt patients with a previous history of suicide attempts. Among these, 1335 patients (62.2%) had received psychiatric treatment in previous suicide attempts. Mortality was significantly different between the psychiatric consultation group (n = 33, 2.5%) and non-consultation group (n = 47, 5.8%) (P < 0.01). In multivariate logistic regression analysis, previous psychiatric consultation showed a significant association with low mortality (adjusted OR 0.41; 95% CI [0.23-0.72]) and selecting non-fatal suicide methods (adjusted OR 0.47; 95% CI [0.36-0.61]). CONCLUSION Patients who received psychiatric consultation in previous suicide attempts had a lower suicide-related mortality in current ED visits as compared to patients who did not, and this may have been related to choosing non-fatal suicide methods.
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Affiliation(s)
- Jeong Min Son
- Department of Emergency Medicine, Seoul National University Hospital, South Korea
| | - Joo Jeong
- Department of Emergency Medicine, Seoul National University Hospital, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea.
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University Hospital, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea
| | - Wonpyo Hong
- Department of Emergency Medicine, Seoul National University Hospital, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Hospital, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea
| | - Kyoung-Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea; Department of Emergency Medicine, Seoul National University Boramae Medical Center, South Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, South Korea
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Constant observation of pediatric patients at risk for self-harm and suicide: An evidence-based practice inquiry. Appl Nurs Res 2020; 55:151294. [PMID: 32532475 DOI: 10.1016/j.apnr.2020.151294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/14/2020] [Accepted: 05/07/2020] [Indexed: 11/20/2022]
Abstract
Suicide is a leading cause of death for pediatric patients in the United States. The utilization of protective observation strategies, namely constant observation, is a regulatory recommendation as part of a comprehensive suicide prevention plan for hospitalized behavioral health patients. Constant observation is the increased level of observation and supervision with continuous one-to-one monitoring techniques, taken to assure the safety and well-being of a patient and others in the patient care environment (Moore et al., 1995). This evidence-based practice inquiry describes a search for the best evidence on constant observation practices ensuring the safe care of pediatric patients at risk for self-harm or suicide. The findings included no high-level evidence, however four literary themes related to the challenges of constant observation emerged: confusing language and definitions, untested models of care, important privacy issues and lack of pediatric observation strategies for patients at risk for self-harm and suicide. Impaired communication underscored each of the themes.
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Nentwich LM, Wittmann CW. Emergency Department Evaluation of the Adult Psychiatric Patient. Emerg Med Clin North Am 2020; 38:419-435. [PMID: 32336334 DOI: 10.1016/j.emc.2020.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Many patients with acute behavioral or mental health emergencies use the emergency department for their care. Psychiatric patients have a higher incidence of chronic medical conditions and are at greater risk for injury than the general population. Patients with acute behavioral emergencies may stress already overcrowded emergency departments. This article addresses high-risk areas of the treatment and management of emergency department patients presenting with behavioral emergencies. This article identifies methods successful in determining whether the patient's behavioral emergency is the result of an organic disease process, as well as recognizing other potential acute medical emergencies in this high-risk population.
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Affiliation(s)
- Lauren M Nentwich
- Department of Emergency Medicine, Boston University Medical Center, One Boston Medical Center Place, BCD Building, Boston, MA 02118, USA.
| | - Curtis W Wittmann
- Department of Psychiatry, Massachusetts General Hospital, Founders 826, 55 Fruit Street, Boston, MA 02114, USA
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Wilson MP, Moutier C, Wolf L, Nordstrom K, Schulz T, Betz ME. ED recommendations for suicide prevention in adults: The ICAR2E mnemonic and a systematic review of the literature. Am J Emerg Med 2020; 38:571-581. [DOI: 10.1016/j.ajem.2019.06.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 01/28/2023] Open
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Gentil L, Huỳnh C, Grenier G, Fleury MJ. Predictors of emergency department visits for suicidal ideation and suicide attempt. Psychiatry Res 2020; 285:112805. [PMID: 32035375 DOI: 10.1016/j.psychres.2020.112805] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/09/2020] [Accepted: 01/19/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study investigated predictors of emergency department (ED) visits for suicidal ideation and suicide attempt in 2014-15 among patients at six Quebec emergency departments (ED), using administrative data. METHODS Participants (n = 11,778) used ED for suicidal ideation (30.4%); suicide attempt (7.0%); or other reasons (61.7%). A multinomial logistic regression was performed using variables described by the Andersen Behavioral Model. RESULTS The odds of ED visits for suicidal ideation or suicide attempt was high for adjustment disorders, personality disorders, and prior ED consultations for mental health (MH) reasons, but lower for schizophrenia spectrum and other psychotic disorders, illness acuity levels 3-5 (low severity), and 3+ consultations with outpatient psychiatrists. The odds of visiting ED for suicidal ideation increased in depressive disorders, and in the 12-17 year age range, but decreased in association with 1-2 outpatient psychiatrist consultations. The odds of suicide attempt also increased with alcohol use disorders and drug-induced disorders, but decreased with specific MH interventions at local community health services centers. CONCLUSION increasing access to ambulatory care, and care continuity in outreach programs for acute MH disorders, including substance-related disorders, may reduce ED visits for suicidal ideation and suicide attempt, while improving overall service delivery.
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Affiliation(s)
- Lia Gentil
- Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada; Institut universitaire sur les dépendances, 950 Louvain East, Montréal, Québec H2M 2E8, Canada; Psychiatry Department, McGill University, Canada
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances, 950 Louvain East, Montréal, Québec H2M 2E8, Canada; School of Psychoeducation, Université de Montréal, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada; Institut universitaire sur les dépendances, 950 Louvain East, Montréal, Québec H2M 2E8, Canada; Psychiatry Department, McGill University, Canada.
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Worsley D, Barrios E, Shuter M, Pettit AR, Doupnik SK. Adolescents' Experiences During "Boarding" Hospitalization While Awaiting Inpatient Psychiatric Treatment Following Suicidal Ideation or Suicide Attempt. Hosp Pediatr 2019; 9:827-833. [PMID: 31653656 PMCID: PMC7307268 DOI: 10.1542/hpeds.2019-0043] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Two million adolescents experience suicidal ideation (SI) or suicide attempt (SA) annually, and they frequently present to emergency departments. Delays in transfer to inpatient psychiatric units increasingly lead to "boarding" in emergency departments and inpatient medical units. We sought to understand adolescents' perspectives during boarding hospitalizations to gain insight into helpful practices and targets for improvement. METHODS Using convenience sampling, we conducted semistructured interviews with 27 adolescents hospitalized for SI or SA while they were awaiting transfer to an inpatient psychiatric facility. Interviews were recorded and transcribed, and the thematic analysis was organized using NVivo 11. RESULTS Eight themes emerged: (1) supportive clinical interactions, (2) information needs, (3) repetitive inquiries, (4) safety, (5) previous hospital experiences, (6) activities and boredom, (7) physical comfort, and (8) emotions. Adolescents expressed appreciation for compassionate clinicians and for receiving information about what to expect, experienced the hospital as a safe environment, emphasized the value of staying occupied and of physical comfort, and were relieved to be receiving help to reduce their suicidal thoughts or behaviors. Reports of embarrassment and discomfort about repeated inquiries from the clinical team, comparisons with previous hospital experiences, and unanswered questions about what would occur during the planned inpatient psychiatric hospitalization were common. CONCLUSIONS The perspectives of adolescents seeking care for SI or SA are an important source of information for health care systems seeking to improve hospital care. Clinicians can relieve distress of adolescents awaiting psychiatric hospitalization by focusing on compassionate connection, minimizing repeated inquiries, and providing complete and concrete information about treatment plans.
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Affiliation(s)
- Diana Worsley
- Center for Pediatric Clinical Effectiveness, PolicyLab, and Division of General Pediatrics and
| | - Emily Barrios
- Center for Pediatric Clinical Effectiveness, PolicyLab, and Division of General Pediatrics and
| | - Marie Shuter
- Department of Nursing, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | | | - Stephanie K Doupnik
- Center for Pediatric Clinical Effectiveness, PolicyLab, and Division of General Pediatrics and
- Leonard Davis Institute of Health Economics and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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If You Could Change 1 Thing to Improve the Quality of Emergency Care for Deliberate Self-harm Patients, What Would It Be? A National Survey of Nursing Leadership. J Emerg Nurs 2019; 45:661-669. [PMID: 31495507 DOI: 10.1016/j.jen.2019.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Emergency departments increasingly treat patients for deliberate self-harm. This study sought to understand emergency department nursing leadership perspectives on how to improve the quality of emergency care for these patients. METHODS ED nursing managers and directors from a national sample of 476 hospitals responded to an open-ended question asking for the 1 thing they would change to improve the quality of care for self-harm patients who present in their emergency departments. We identified and coded key themes for improving the emergency management of these patients, then examined the distribution of these themes and differences by hospital characteristics, including urbanicity, patient volume, and teaching status. RESULTS Five themes regarding how to improve care for deliberate self-harm patients were identified: greater access to hospital mental health staff or treatment (26.4%); better access to community-based services and resources (26.4%); more inpatient psychiatric beds readily accessible (20.9%); separate safe spaces in the emergency department (18.6%); and dedicated staff coverage (7.8%). Endorsement of findings did not differ based on hospital characteristics. DISCUSSION ED nursing leadership strongly endorsed the need for greater access to both hospital- and community-based mental health treatment resources for deliberate self-harm patients. Additional ED staff and training, along with greater continuity among systems of care in the community, would further improve the quality of emergency care for these patients. Broad policies that address the scarcity of mental health services should also be considered to provide comprehensive care for this high-risk patient population. KEY WORDS Emergency department management of self-harm; Mental health care; Emergency nursing care.
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Maina R, Bukusi D, Kumar M. Suicide prevention by emergency nurses: perceived self-efficacy in assessment, management and referral at Kenyatta National Hospital in Kenya. Ann Gen Psychiatry 2019; 18:16. [PMID: 31462903 PMCID: PMC6710859 DOI: 10.1186/s12991-019-0240-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 08/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency Departments are underutilized settings for suicide prevention and management as patients with occult (camouflaged) suicides and suicidal ideation are rarely screened by nurses and other health workers in these sites. The under-detection rates could be a result of lack of suicide assessment and management confidence among the hospital staff. The aim of the study was to find out the perceived self-efficacy in suicide risk assessment, management and referral among nurses working in an emergency department within a lower income country. METHOD The Risk Assessment and Management Self-Efficacy Scale (RAMSES) was administered among nurses in an emergency department (ED) within an urban region in a descriptive study. The risk assessment, management and referral domains among 64 respondents were evaluated using mean and standard deviation calculations in SPSS v 21. RESULTS The total RAMSES composite score in risk assessment, management and referral was 6.19 (SD 2.107) with risk assessment having the lowest mean score of 6.09 (SD 2.08), while risk referral process mean score was the highest at 6.55 (SD 2.36). The nurses had the least confidence in developing a written risk management plan 5.68 (SD 2.51) as well as using screening instruments to assess risk 5.90 (SD 2.15). FINDINGS Nurses in emergency department have below average self-efficacy in suicide assessment and management necessitating training as well as integration of protocols that could enhance effective utilization of emergency departments as suicide prevention and management settings.
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Affiliation(s)
- Rachel Maina
- Clinical Psychologist University of Nairobi, 10834-00400, Nairobi, Kenya
- Tilburg University, Tilburg, The Netherlands
| | - David Bukusi
- Head of VCT and HIV Prevention/Youth Center KNH, Nairobi, Kenya
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Virk P, Laskin S, Gokiert R, Richardson C, Newton M, Stenstrom R, Wright B, Black T, Doan Q. MyHEARTSMAP: development and evaluation of a psychosocial self-assessment tool, for and by youth. BMJ Paediatr Open 2019; 3:e000493. [PMID: 31414065 PMCID: PMC6668754 DOI: 10.1136/bmjpo-2019-000493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/17/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Paediatric mental health-related visits to the emergency department are rising. However, few tools exist to identify concerns early and connect youth with appropriate mental healthcare. Our objective was to develop a digital youth psychosocial assessment and management tool (MyHEARTSMAP) and evaluate its inter-rater reliability when self-administered by a community-based sample of youth and parents. METHODS We conducted a multiphasic, multimethod study. In phase 1, focus group sessions were used to inform tool development, through an iterative modification process. In phase 2, a cross-sectional study was conducted in two rounds of evaluation, where participants used MyHEARTSMAP to assess 25 fictional cases. RESULTS MyHEARTSMAP displays good face and content validity, as supported by feedback from phase 1 focus groups with youth and parents (n=38). Among phase 2 participants (n=30), the tool showed moderate to excellent agreement across all psychosocial sections (κ=0.76-0.98). CONCLUSIONS Our findings show that MyHEARTSMAP is an approachable and interpretable psychosocial assessment and management tool that can be reliably applied by a diverse community sample of youth and parents.
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Affiliation(s)
- Punit Virk
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Samara Laskin
- Pediatrics, University of British Columbia, Vancouver, British of Columbia, Canada
| | - Rebecca Gokiert
- Faculty of Extension, University of Alberta, Edmonton, Alberta, Canada
| | - Chris Richardson
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mandi Newton
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Rob Stenstrom
- Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bruce Wright
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Tyler Black
- Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Quynh Doan
- Pediatrics, University of British Columbia, Vancouver, British of Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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Schmutte T, Olfson M, Xie M, Marcus SC. Deliberate self-harm in older adults: A national analysis of US emergency department visits and follow-up care. Int J Geriatr Psychiatry 2019; 34:1058-1069. [PMID: 30933388 PMCID: PMC6579649 DOI: 10.1002/gps.5109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 03/20/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine mental health care received by older adults following emergency department (ED) visits for deliberate self-harm. METHODS This retrospective cohort analysis examined 2015 Medicare claims for adults ≥65 years of age with ED visits for deliberate self-harm (N = 16 495). We estimated adjusted risk ratios (ARR) for discharge disposition, ED coding of mental disorder, and 30-day follow-up mental health outpatient care. RESULTS Most patients (76.9%) were hospitalized with lower likelihoods observed for African American patients (ARR = 0.86, 99% CI = 0.79-0.94) and patients with either one medical comorbidity (ARR = 0.91, 99% CI = 0.83-0.99) or two to three comorbidities (ARR = 0.93, 99% CI = 0.88-0.99). Hospitalization was associated with recent depression (ARR = 1.09, 99% CI = 1.03-1.16) and recent psychiatric inpatient care (ARR = 1.13, 99% CI = 1.04-1.22). Among patients discharged to the community (n = 3818), 56.4% received an ED mental disorder diagnosis. Predictors of an ED mental disorder diagnosis included younger age (65-69 years; ARR = 1.53, 99% CI = 1.31-1.78), recent mental health care in ED (ARR = 1.50, 99% CI = 1.29-1.74) or outpatient (ARR = 1.62, 99% CI = 1.44-1.82) settings, recent diagnosis of mental disorder (ARR = 1.61, 99% CI = 1.43-1.80), and other/unknown lethality methods of self-harm (ARR = 1.24, 99% CI = 1.01-1.52). Among community discharged patients, 39.0% received 30-day follow-up outpatient mental health care, which was most strongly predicted by an ED diagnosis of mental disorder (ARR = 2.65, 99% CI = 2.25-3.12) and prior outpatient mental health care (ARR = 2.62, 99% CI = 2.28-3.00). CONCLUSION Most older adult Medicare beneficiaries who present to EDs with self-harm are hospitalized. Of those who are discharged to the community, many are not diagnosed with mental disorder in the ED or receive timely follow-up mental health care.
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Affiliation(s)
- Timothy Schmutte
- Yale University, Department of Psychiatry, Program for Recovery and Community Health
| | - Mark Olfson
- Columbia University, Department of Psychiatry and the New York State Psychiatric Institute
| | - Ming Xie
- University of Pennsylvania, Department of Psychiatry
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Abstract
It is widely believed that suicide prevention involves the consideration of risk and protective factors and related interventions. Preventative interventions can be classified as “universal” (targeting whole populations), “selective” (targeting higher-risk groups), and “indicated” (protecting individuals). This review explores the range of preventative measures that might be used commensurately with different types of suicide prediction. The author concludes that the best prospects for suicide prevention lie in universal prevention strategies. While risk assessments do generate some information about future suicide, suicide risk categorization results in an unacceptably high false positive rate, misses many fatalities, and therefore, is unable to usefully guide prevention strategies. The assessment of suicidal patients should focus on contemporaneous factors and the needs of the patient, rather than probabilistic notions of suicide risk.
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Affiliation(s)
- Matthew Michael Large
- Mental Health Services, The Prince of Wales Hospitals, Barker Street, Randwick, NSW, 2031, Australia
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Urban C, Arias SA, Segal DL, Camargo CA, Boudreaux ED, Miller I, Betz ME. Emergency Department patients with suicide risk: Differences in care by acute alcohol use. Gen Hosp Psychiatry 2018; 63:83-88. [PMID: 30293842 PMCID: PMC6433543 DOI: 10.1016/j.genhosppsych.2018.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/27/2018] [Accepted: 09/22/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To compare Emergency Department (ED) care of suicidal patients with and without documented acute alcohol use. METHODS Retrospective chart review of randomly sampled patient visits (n = 800; January 2014 to December 2015) at an urban ED with universal screening for suicide risk. Eligible visits were by adults (18+ years) who screened positive for suicide risk at the ED visit (i.e., suicidal ideation in past two weeks or suicide attempt in past six months). Analyses compared those with and without documentation of acute alcohol use. RESULTS Among these patients with suicide risk, 19% had documented acute alcohol use (versus 43% with no use and 38% without documentation); individuals with acute alcohol use were more often male and aged 35-59 years. Overall, 62% were evaluated by a mental health professional in the ED. Individuals with acute alcohol use were significantly less likely (vs those without use) to be evaluated by a mental health professional in the ED (odds ratio 0.49, 95%CI 0.28-0.87) after adjustment for age, recent suicide ideation, current suicide plan, self-harm as a chief complaint, contact with family, and ED disposition. CONCLUSIONS Although alcohol use can increase suicide risk, ED patients with acute use appear to receive less thorough suicide risk assessments.
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Affiliation(s)
- Chantel Urban
- Colorado School of Public Health; Aurora, Colorado, USA,Department of Emergency Medicine, University of Colorado School of Medicine; Aurora, Colorado, USA
| | - Sarah A. Arias
- Department of Psychiatry and Human Behavior, Brown University, Butler Hospital, Providence, RI, USA
| | - Daniel L. Segal
- Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs, CO, USA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Edwin D. Boudreaux
- Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Ivan Miller
- Department of Psychiatry and Human Behavior, Brown University, Butler Hospital, Providence, RI, USA
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado School of Medicine; Aurora, Colorado, USA
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48
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Aboumrad M, Fuld A, Soncrant C, Neily J, Paull D, Watts BV. Root Cause Analysis of Oncology Adverse Events in the Veterans Health Administration. J Oncol Pract 2018; 14:e579-e590. [PMID: 30110226 DOI: 10.1200/jop.18.00159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Oncology providers are leaders in patient safety. Despite their efforts, oncology-related medical errors still occur, sometimes resulting in patient injury or death. The Veterans Health Administration (VHA) National Center of Patient Safety used data obtained from root cause analysis (RCA) to determine how and why these adverse events occurred in the VHA, and how to prevent future reoccurrence. This study details the types of oncology adverse events reported in VHA hospitals and their root causes and suggests actions for prevention and improvement. METHODS We searched the National Center for Patient Safety adverse event reporting database for RCA related to oncology care from October 1, 2013, to September 8, 2017, to identify event types, root causes, severity of outcomes, care processes, and suggested actions. Two independent reviewers coded these variables, and inter-rater agreement was calculated by κ statistic. Variables were evaluated using descriptive statistics. RESULTS We identified 48 RCA reports that specifically involved an oncology provider. Event types included care delays (39.5% [n = 19]), issues with chemotherapy (25% [n = 12]) and radiation (12.5% [n = 6]), other (12.5% [n = 6]), and suicide (10.5% [n = 5]). Of the 48 events, 27.1% (n = 13) resulted in death, 4.2% (n = 2) in severe harm, 18.8% (n = 9) in temporary harm, 20.8% (n = 10) in minimal harm, and 2.1% (n = 1) in no harm. The majority of root causes identified a need to improve care processes and policies, interdisciplinary communication, and care coordination. CONCLUSION This analysis highlights an opportunity to implement system-wide changes to prevent similar events from reoccurring. These actions include comprehensive cancer clinics, usability testing of medical equipment, and standardization of processes and policies. Additional studies are necessary to assess oncologic adverse events across specialties.
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Affiliation(s)
- Maya Aboumrad
- National Center for Patient Safety; White River Junction VA Medical Center, White River Junction, VT; The National Center for Patient Safety, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Alexander Fuld
- National Center for Patient Safety; White River Junction VA Medical Center, White River Junction, VT; The National Center for Patient Safety, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Christina Soncrant
- National Center for Patient Safety; White River Junction VA Medical Center, White River Junction, VT; The National Center for Patient Safety, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Julia Neily
- National Center for Patient Safety; White River Junction VA Medical Center, White River Junction, VT; The National Center for Patient Safety, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Douglas Paull
- National Center for Patient Safety; White River Junction VA Medical Center, White River Junction, VT; The National Center for Patient Safety, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Bradley V Watts
- National Center for Patient Safety; White River Junction VA Medical Center, White River Junction, VT; The National Center for Patient Safety, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
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49
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McBride SM, Braz VA, Jones CW. Occult Suicidality and Psychiatric Disease Among Emergency Department Patients with Low-acuity Chief Complaints. West J Emerg Med 2018; 19:573-578. [PMID: 29760858 PMCID: PMC5942027 DOI: 10.5811/westjem.2018.2.36399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/19/2017] [Accepted: 02/16/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction Patients presenting to emergency departments (ED) are often screened for suicidality, even when their chief complaint does not involve mental health concerns. Patient receptiveness to ED-based mental health screening and intervention is unknown, particularly among patients with low-acuity chief complaints, who often prioritize rapid evaluation and discharge. Methods This cross-sectional study included adults with low-acuity chief complaints presenting to an urban, academic ED in the Northeastern United States during daytime and evening hours, from 2015 to 2016. Participants completed validated mental health screening instruments, including the Suicide Behaviors Questionnaire-Revised and the Patient Health Questionnaire-4. Participants were also asked to rate the importance of addressing mental health concerns during their ED visit. Results We approached 1,688 patients, and 816 (48.4%) consented to participate in the study. Of these, 27% screened positive for anxiety and 25% screened positive for depression. Even among patients with no prior depression history, 17% were at high risk of depression. Eleven percent of participants were at high risk for suicidal behavior, including 5% of those with no reported history of depression or bipolar disorder. Thirty-five percent of patients at risk for suicide and 53% of those at high risk of depression thought it was important or very important to address these issues during the ED visit. Conclusion Symptoms of mental health disorders were common among this group of ED patients presenting with low-acuity chief complaints. Patients often desired to address these mental health concerns as part of their ED visit.
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Affiliation(s)
- Stephen M McBride
- Cooper Medical School of Rowan University, Department of Emergency Medicine, Camden, New Jersey
| | - Valerie A Braz
- Cooper Medical School of Rowan University, Department of Emergency Medicine, Camden, New Jersey
| | - Christopher W Jones
- Cooper Medical School of Rowan University, Department of Emergency Medicine, Camden, New Jersey
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50
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Heyland M, Delaney KR, Shattell M. Steps to Achieve Universal Suicide Screening in Emergency Departments: A Call to Action. J Psychosoc Nurs Ment Health Serv 2018; 56:21-26. [PMID: 29741746 DOI: 10.3928/02793695-20180503-03] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/01/2018] [Indexed: 11/20/2022]
Abstract
American individuals attempt suicide at alarmingly high rates of approximately 1.1 million times per year. Yet the United States has failed to adopt a systematic approach to suicide prevention, particularly via universal screening. Given the increasing number of individuals with suicidal ideation presenting to emergency departments (EDs), all patients who present to the ED for treatment should be screened, as opposed to only individuals with mental health complaints. In the current article, barriers to suicide screening in the ED are discussed, as well as strategies to move ED providers toward the goal of universal screening. The current article entreats nurses to be leaders in achieving universal screening and provides practical actions to begin the process. Specific recommendations for action include improving training, increasing lethal means assessment, and achieving compliance with The Joint Commission suicide screening guidelines. [Journal of Psychosocial Nursing and Mental Health Services, 56(10), 21-26.].
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