245297 A Multicenter Study of Universal Suicide Screening in Emergency Departments

Monday, October 31, 2011

Michael H. Allen, MD , Colorado Depression Center, University of Colorado School of Medicine, Aurora, CO
Beau Abar, Ph D , University of Massachusetts Medical School, Department of Emergency Medicine, Worcester, MA
Mark McCormick, MD , Regional Chief of Quality for Behavioral Health, Kaiser Permanente of Northern California, Santa Clara, CA
Donna H. Barnes, Ph D , Department of Psychiatry, Howard University, Washington, DC
Jason Haukoos, MD, MSc , Department of Emergency Medicine, Denver Health Medical Center, Denver, CO
Edwin Boudreaux, PhD , Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA
Background: JCAHO National Patient Safety Goal 15 calls for organizations “to identify patients at risk for suicide”. Overt suicidal behavior accounts for 0.6% of Emergency Department (ED) visits but occult suicidal ideation (SI) has been reported in 3-11% of visits. This is the first multicenter study of universal suicide screening in EDs. Methods: Trained research assistants screened English speaking patients >=18 years old at six ED's with diverse models and populations. Participants presented with medical complaints but were not incapacitated and provided consent. Those with primary psychiatric complaints were excluded. A 5-item instrument was administered including the first two PHQ-9 items and the Columbia Suicide Severity Rating Scale items passive SI, active SI and attempts. Positive screens were communicated to providers. Results: Of 2243 eligible patients, 1069 consented and had complete data (47.7%). Depression items were endorsed by 369 (34.5%); passive SI by 79 (7.3%); and active SI by 24 (2.25%). The majority with SI endorsed depression items but 7/79 with passive (8.9%) and 2/24 with active SI (8.3%) did not endorse depression items. There were 140 (13%) with prior attempts including 35/79 (44.3%) with passive and 12/24 (50%) with active SI. Conclusions: The prevalence of SI here is similar to previous studies but the high frequency of prior attempts has not been reported. The 35 cases with current SI and attempt history (3.3%) must be viewed as high risk and, as they did not present with a psychiatric complaint, they would not have been detected.

Learning Areas:
Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines

Learning Objectives:
1. Attendees will be able to describe a rapid method of screening individuals for occult suicide risk in emergency settings. 2. Attendees will be able to describe the prevalence of occult suicidal ideation and behavior in emergency settings. 3. Attendees will be to identify low, moderate and high risk patients on the basis of simple screening.

Keywords: Suicide, Injury Prevention

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I was one of the collaborators and the PI for our study. I have been presenting for over 15 years on suicide prevention and intervention and run several suicide prevention programs on campus.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.