Every person seeking treatment in an emergency department (ED) gets his or her vital signs (blood pressure, temperature, and pulse) checked. A new research study at Butler Hospital seeks to identify whether incorporating another vitally important screening for all ED patients will help reduce a major health risk — suicide.
According to the National Institutes of Mental Health (NIMH) suicide is a major, preventable public health problem. In 2006, it was the eleventh leading cause of death in the United States, accounting for 33,300 deaths. Current practices for assessing suicidality in ED patients vary widely. “Some EDs provide psychiatric emergency services, while others have less formal structures,” reports Ivan Miller, PhD
, director of Psychosocial Research at Butler Hospital. “However, most do not screen for suicide unless there’s some obvious sign that the patient is at risk.” As a result, patients who present with a clearly identifiable medical condition, such as a heart attack or cancer, which can lead to depression
and thoughts of suicide, could potentially be overlooked.
In collaboration with colleagues Edwin Boudreaux, PhD, at the University of Massachusetts and Carlos Camargo, MD, at Massachusetts General Hospital, Dr. Miller is conducting a five-year, three-phase longitudinal study in eight EDs around the country, including Memorial Hospital in Rhode Island, to determine the effectiveness of suicide detection and prevention.
The first phase of the study will evaluate how suicide risk is typically assessed and treated in EDs (treatment as usual, or TAU) among patients who have obvious psychiatric risk factors such as depression. Often these patients are put under observation while at the hospital and are evaluated by a mental health clinician. They may also be referred to a mental health professional outside the hospital, but few receive adequate follow-up care after they are discharged.
In the second phase, a universal screening tool for suicidal ideation will be used with all ED patients regardless of whether they have typical risk factors for suicidality. The screening includes a few brief questions to assess risk of suicide that will be asked of every patient who comes into the ED. Researchers will compare universal screening with TAU to determine how well each detects suicidal patients.
In the third phase, a more intensive intervention that includes screening, brief counseling, and referral to outpatient care will be implemented in the ED. Additionally, study patients will receive a modified version of an intervention called CLASP (Coping Long-term with Attempted Suicide Program), which was developed by Dr. Miller and his team of researchers at Butler. For this study, CLASP consists of a series of telephone calls with the patient and his or her significant other over six months post-discharge. Butler clinicians will provide this intervention for all eight ED sites. This intervention will be compared with both TAU and the universal screening.
The study is being funded with a $12 million dollar grant from NIMH. With the goal of studying more than 1,400 patients, Dr. Miller hopes to demonstrate that assessment of all ED patients for suicidal tendencies, in conjunction with an intervention and follow-up, will reduce the rate of suicide and ultimately result in the addition of suicide prevention to vital-sign checks for all ED patients.
More information on Butler Hospital research studies
More information about depression
More information about suicide prevention