A Multicenter Study of Universal Suicide Screening in Emergency Departments

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.