Suicide risk among adults with mental health emergency department visits with and without suicidal symptoms

Objective: The authors 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) […]

The serious self-harm risk of “mixed presenters,” People who presented to New Zealand emergency departments for self-harm and other reasons: A cohort study

The objective of this study was to investigate if “Mixed Presenters,” people who present to emergency departments at least twice within 28 days, once for self-harm and once for another reason (any order), have an increased risk of subsequent serious self-harm compared to self-harm only repeat presenters. Self-harm coded emergency department data from the Multi-level […]

Adherence to guideline creation recommendations for suicide prevention in the emergency department: A systematic review

eSuicide rates are rising in the United States. 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 […]

Clinical severity alone does not determine disposition decisions for patients in the emergency department with suicide risk

BACKGROUND: Boarding of patients with suicide risk in emergency departments (EDs) negatively affects both patients and society. Factors other than clinical severity may frequently preclude safe outpatient dispositions among suicidal patients boarding for psychiatric admission in the ED. OBJECTIVE: To determine the extent to which nonclinical factors preclude safe outpatient discharge from the ED among […]

The emergency department challenges and opportunities for suicide prevention

Emergency services can offer life-saving suicide prevention care. Brief therapeutic interventions initiated in the emergency department (ED) for youths presenting with suicide/self-harm risk can improve continuity of care and connections with outpatient follow-up treatment, a national suicide prevention objective. A care process model and clinical guidance are offered based on current scientific evidence. Effective treatment strategies for […]

Feasibility and effects of a web-based adolescent psychiatric assessment administered by clinical staff in the pediatric emergency department.

Objectives  To determine the adoption rate of the Web-based Behavioral Health Screening–Emergency Department (BHS-ED) system during routine clinical practice in a pediatric ED, and to assess this system’s effect on identification and assessment of psychiatric problems. Design  Descriptive design to evaluate the feasibility of a clinical innovation. Setting  The ED of an urban tertiary care […]

Examining the impact of suicide attempt function and perceived effectiveness in predicting reattempt for emergency medicine patients.

Abstract While previous studies have examined motivational aspects of self-directed violence, few studies have included specific motivations in predictive models for future suicide attempts. The current study utilized a sample of 160 individuals treated in an acute emergency setting following a suicide attempt who completed an interview battery that included an assessment of functional aspects […]

Multicenter study of predictors of suicide screening in emergency departments.

Objectives:   The objective was to provide estimates and predictors of screening for suicide in emergency departments (EDs). Methods:   Eight geographically diverse U.S. EDs each performed chart reviews of 100 randomly selected patients, ages 18 years or older, with visits in October 2009. Trained chart abstractors collected information on patient demographics, presentation, discharge diagnosis, […]

Management of the suicidal child or adolescent in the emergency department.

The pediatrician may be called on either as the primary physician or as a consultant to see a suicidal child or adolescent in the emergency department. Psychiatric consultation may not be available immediately. The pediatrician will then play a pivotal role in the evaluation and disposition of the patient. We discuss the epidemiology, initial approach […]

The association between bankruptcy and hospital-presenting suicide: A record linkage study.

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Suicide mortality of suicide attempt patients discharged from emergency room, nonsuicidal psychiatric patients discharged from emergency room, admitted suicide attempt patients and admitted nonsuicidal psychiatric patients.

The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients admitted for suicide attempt, and psychiatric […]

Profile of a Metropolitan North American Immigrant Suicidal Adolescent Population

Emergency/crisis Coverage of a Suicidal Patient

Parasuicide Assessment in the Emergency Department

Problem-Solving Intervention for Suicidal Crises in the Psychiatric Emergency Service

In this article the authors attempt to answer the question, “How would a cognitive-behavioral problem-solving approach translate to the reality of a hectic emergency psychiatric unit?” They present a strategy for applying such a problem-solving approach to suicidal patients in the Psychiatric Emergency Service (PES) which involves identifying patients for whom it would be effective, […]

Behavioral Emergencies and Crises: an Overview

This article discusses the importance for clinical psychologists of acquiring a knowledge base & the clinical skills needed to evaluate & manage behavioral crises & emergencies. The author comments on how clinical psychology as a field has been slow to come to the realization that there is a need for more systematic training in this […]

Attenders of a University Hospital Psychiatric Emergency Service in Belgium: General Characteristics and Gender Differences

The aim of this study was to provide a clinical & epidemiological profile of patients consulting the psychiatric emergency team of a Belgium emergency service. Results showed that male patients presented more with hostility or violence towards others & substance abuse, whereas female patients presented more with suicidality & depressed mood. Implications for effective psychiatric […]

Consultation Versus Research Diagnoses of Mental Disorders Among Suicide Attempters

The authors investigated discrepancies between the routine psychiatric emergency consultation & the research diagnoses of mental disorders among suicide attempters. The findings presented, based on a sample 114 suicide attempters in Helsinki, suggest that important medical disorders, & their comorbidity, are often not diagnosed in emergency consultations. (22 refs)

Discovering the Truth in Attempted Suicide

The findings of an international workshop on improving clincial interactions between mental health workers & suicidal patients are reported. Experts identified common contemporary problems when interviewing suicide attempters. Videotaped interviews were critically discussed in relation to expert experience & the existing literature in this area. The group concluded that clinicians should strive for a shared […]

Suicide Assessment in Child and Adolescent Emergency Psychiatry (IN: Handbook of Child and Adolescent Psychiatry, v.7, ed. by P L Adams and E Bleiberg)

This chapter discusses the assessment of suicidality when a young person presents in a psychiatric emergency. Precipitants of suicidal behaviour, risk factors, & protective factors are presented. The author stresses the importance of accurate assessment & briefly comments on involuntary hospitalization of young children to lower the risk of suicide. (32 refs) (SC)

Emergency Psychiatry and the Suicidal Patient

This column marks a new feature in Crisis: a discussion of clinical & research issues related to suicide based in the field of emergency psychiatry. The column will feature experts in emergency psychiatry, writing about issues that lie at the interface of suicidology & emergency psychiatry. This first column examines the relevance of emergency psychiatric […]

An Evidence-Based Approach to Evaluating and Managing Suicidal Emergencies

This article presents a framework for making suicide risk estimations, as well as recommendations for the management of suicidal emergencies, that are useful to the practitioner. It provides a review of existing empirical data concerning factors significantly related to acute suicidal behaviors within high-risk diagnosis. The article also addresses related management issues such as the […]

A Rapid-Response Outpatient Model for Reducing Hospitalization Rates Among Suicidal Adolescents

The authors studied the clinical outcomes of suicidal adolescents who were treated within a rapid-response outpatient model in a setting in which a 10-day wait was usually required before outpatient treatment could be started, leaving hospitalization as the only immediately available alternative. Findings suggest that suicidal adolescents can be treated effectively within a rapid-response outpatient […]