Screening for occult suicidal ideation in emergency department patients without mental health complaints

Purpose: This study investigated the feasibility of screening every patient at a university hospital ED for suicidal ideation (SI).Methods: A simple questionnaire was developed comprised of two items assessing depression and three addressing passive and active SI, and lifetime attempts. Over 6 shifts, research staff consented and screened all eligible subjects 18-89 years old, English speaking, and not incapacitated by their presenting medical problem.Results: There were 405 potential subjects139 were excluded and 49 refused leaving 219 (54%) who were eligible and consented. Average screen administration time was 3.3 min. There were 47 depressed, 39 anhedonic and 27 both. Nine patients reported SI (4.1%), all endorsing passive and 3 (1.4%) also endorsing active SI. A prior attempt was reported by 41 (18.7%). All 3 with active SI had a prior attempt of which 2 were recent. Of 6 with passive but not active SI, 2 had remote attempts. The remaining 35 prior attempters denied SI. One patient endorsed anhedonia but not depression and had passive SI. The emergency physician was notified of the SI for each of the 9 cases and usual care ensued; 2 were referred to the ED's mental health consultants and released to outpatient care; 6 were further assessed by the emergency physician and released. In one case, there is no record of further assessment.Conclusion: Suicidal ideation or behavior was common. One question about depression identified 89% of otherwise undetected SI. Most received additional attention and were released but one (11%) did not.