Suicide Prevention in an Emergency Department Population: The ED-SAFE Study

Among patients who presented to an emergency department for acute suicide risk, CLASP was associated with a 20% reduction in suicide attempts versus treatment as usual.

“Among patients who presented to an emergency department for acute suicide risk, CLASP was associated with a 20% reduction in suicide attempts versus treatment as usual (Miller et al., 2017).”

The meta-analysis included four randomised controlled trials, one non-randomised controlled trial, and one interrupted time-series design.

“The meta-analysis included four randomised controlled trials, 12,13,29,30 a non-randomised controlled trial 18 and one study with an interrupted time-series design.17”

Screening in EDs without an associated follow-up intervention to bolster treatment adherence and adherence to a safety plan is no better than usual care, whereas screening coupled with follow-up calls can reduce suicide attempts relative to usual care in the ED.

“However, screening in EDs without an associated follow-up intervention to bolster treatment adherence and adherence to a safety plan is no better than usual care, whereas screening coupled with follow-up calls can reduce suicide attempts relative to usual care in the ED 215 .”

In a multicentre study conducted in 8 emergency departments, 1,376 patients were assigned to usual care, universal screening, or universal screening plus a brief intervention; only the latter resulted in a 5% risk reduction in suicide attempts in the subsequent year (OR=0.72).

“universal screening plus a brief intervention, with only the latter resulting in a 5% risk reduction in suicide attempts in”

The ED-SAFE intervention resulted in fewer suicide attempts over a year compared to treatment as usual.

“The ED-SAFE intervention resulted in fewer suicide attempts over a year compared to treatment as usual 215 .”

Individual trials on the effectiveness of SPTIs have yielded conflicting results.

“Individual trials on the effectiveness of SPTIs have yielded conflicting results, 17,18”

Intention-to-treat data were extracted when possible; five studies had ITT data and one had only completers' data.

“Intention-to-treat data could be extracted from five studies, 12,13,17,18,30 and one study had only study completers' data available.29”

Using the low-burden intervention in this project and others was associated with about the same reduction in suicidal behavior as more intensive and costly psychosocial interventions.

“Importantly, using the low-burden intervention in this project and others 30 was associated with about the same reduction in suicidal behavior as more intensive and costly psychosocial interventions.43,44”

Our results are also consistent with past research that found that a combination of in-person intervention using screening and a safety plan coupled with telephone follow-up reduced suicide attempts.

“Our results are also consistent with past research 30 that found that a combination of in-person intervention using screening and a safety plan coupled with telephone phone follow-up reduced suicide attempts.”

One ED study found a 30% lower suicide attempt rate with an intervention consisting of screening, providing basic written material on safety planning, and several calls to suicidal patients and their significant others.

“One ED study found a 30% lower suicide attempt rate with an intervention consisting of screening, providing basic written material on safety planning, and several calls to suicidal patients and their significant others.30”

Screening and assessment in itself will not improve outcomes unless it leads to effective intervention.

“Screening and assessment in itself will not improve outcomes, unless it leads to effective intervention.34”

Studies reporting a standard approach to missing data, including multiple imputation or last observation carried forward, were rated medium risk.

“Studies that described a standard method for handling missing data during analysis, such as multiple imputation or last observation carried forward, were assigned a medium risk score. 15,16,18,19,24,25”

Seven studies (50%) assessed subsequent suicide attempts.

“Seven studies (50%) examined subsequent suicide attempts as an outcome, [16][17][18]21,23,24,28”

Safety Planning Intervention was the most frequent brief therapeutic approach, appearing in 5 studies.

“The most common brief therapeutic intervention was the Safety Planning Intervention, which was delivered in 5 studies.16,18,24,27,28”

Ten studies provided brief therapeutic approaches that were not Safety Planning Intervention.

“Ten studies delivered brief therapeutic interventions other than a Safety Planning Intervention. 15,18,20,[22]][23][24][25][26][27][28]”

A single study delivered brief caring contacts by text at day 1, week 1, and nine additional points across 12 months, with trained counselors responding to replies.

“One study 18 used text messaging to provide brief caring contacts at 1 day, 1 week, and 9 other times throughout 12 months, and trained counselors responded to recipients' replies either with supportive statements or to ensure the recipient engaged with mental health treatment.”