Screening for suicidality in the emergency department: when must researchers act to protect subjects' interests?

Examining suicide-related presentations to the emergency department

OBJECTIVE

Although the Emergency Department (ED) is a frequent point of contact for individuals with suicide-related behaviour (SRB) or ideation, there is limited literature specifically examining presentations to the ED for SRB. This review examines the international literature published in North America, the United Kingdom and Australia relating to presentations to the ED for SRB, with focus on high-risk groups, screening tools used in the ED, and difficulties in classifying ED presentations of SRB.

METHOD

The database PubMed was searched using relevant terms, and national health care administrative data were reviewed.

RESULTS

Psychiatric history, substance use, and lower socioeconomic status were all found to be associated with higher rates of ED presentations for SRB. Limited research exists around ED presentations of SRB by particular high-risk groups, including lesbian, gay, bisexual, and transgender populations and Indigenous peoples. Individuals who present to EDs for SRB are often chronic users of EDs and have a high rate of repeat self-harm and death by suicide.

CONCLUSION

These findings suggest that EDs could serve as a focal point for suicide treatment interventions. Deepening our understanding of ED presentations for SRB could inform further development and implementation of interventions to reduce death by suicide.

Ethical and Practical Considerations in the Use of a Predictive Model to Trigger Suicide Prevention Interventions in Healthcare Settings

Predictive models that utilize data from electronic healthcare records (EHR) have been developed, investigated, and appear to provide an important resource for suicide prevention in medical settings. Actuarial approaches to predicting suicide may be particularly important given the relative inability of clinicians to accurately predict suicide. Although research regarding predictive models that utilize EHR is certainly promising, ethical considerations for the use of these models to trigger suicide prevention interventions warrant careful consideration. The current manuscript discusses ethical considerations regarding the use of predictive models in suicide prevention clinical care. The unique characteristics of suicide are explored in terms of how they inform ethical and practical approaches. Additionally, biomedical ethical principles and utilitarian, Kantian, and personal rights ethical models are applied to the topic. Recommendations for navigating the ethical issues are provided as an initial framework for others who are considering the implementation of a predictive model to trigger suicide prevention initiatives.