Improving Suicide Risk Screening and Detection in the Emergency Department
Open accessAbstract
Introduction The Emergency Department Safety Assessment and Follow-up Evaluation Screening Outcome Evaluation examined whether universal suicide risk screening is feasible and effective at improving suicide risk detection in the emergency department (ED).Methods A three-phase interrupted time series design was used: Treatment as Usual (Phase 1), Universal Screening (Phase 2), and Universal Screening + Intervention (Phase 3). Eight EDs from seven states participated from 2009 through 2014. Data collection spanned peak hours and 7 days of the week. Chart reviews established if screening for intentional self-harm ideation/behavior (screening) was documented in the medical record and whether the individual endorsed intentional self-harm ideation/behavior (detection). Patient interviews determined if the documented intentional self-harm was suicidal. In Phase 2, universal suicide risk screening was implemented during routine care. In Phase 3, improvements were made to increase screening rates and fidelity. Chi-square tests and generalized estimating equations were calculated. Data were analyzed in 2014.Results Across the three phases (N=236,791 ED visit records), documented screenings rose from 26% (Phase 1) to 84% (Phase 3) (χ(2) [2, n=236,789]=71,000, p<0.001). Detection rose from 2.9% to 5.7% (χ(2) [2, n=236,789]=902, p<0.001). The majority of detected intentional self-harm was confirmed as recent suicidal ideation or behavior by patient interview.Conclusions Universal suicide risk screening in the ED was feasible and led to a nearly twofold increase in risk detection. If these findings remain true when scaled, the public health impact could be tremendous, because identification of risk is the first and necessary step for preventing suicide.Trial registration Emergency Department Safety Assessmentand Follow-up Evaluation (ED-SAFE) ClinicalTrials.gov: (NCT01150994). https://clinicaltrials.gov/ct2/show/NCT01150994?term=ED-SAFE&rank=1.
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Nearly half of individuals who screen positive for suicide risk in the ED do not spontaneously communicate suicidal ideation.
“In addition, other reasons for visiting the ED can increase the risk for suicide (such as trauma or alcohol intoxication), and nearly half of individuals who screen positive for suicide risk in the ED do not spontaneously communicate suicidal ideation 211,212 .”
From Suicide and suicide risk (2019) · cites this paper as [212]
The Discussion (page unavailable) reports that universal screening nearly doubled documented suicide-risk detection, from 2.9% to 5.7%, supporting the point that many patients' risks would otherwise go undetected. The paper does not measure whether patients spontaneously communicated suicidal ideation; its detection measure also includes past attempts and other intentional self-harm. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe role and efficacy of pharmacological antidepressant treatment among patients with cancer with depressive symptoms have not been well studied, particularly in elderly patients.
“Also, the role and efficacy of pharmacological antidepressant treatment among patients with cancer with depressive symptoms have not been well studied, particularly in elderly patients 56,57 .”
From Suicide risk and mortality among patients with cancer (2022) · cites this paper as [56]
In ED-SAFE 1, every site had already put in place clinical protocols to screen all patients for suicide risk using the Patient Safety Screener.
“During ED-SAFE 1, all eight sites had adopted clinical protocols for universal suicide risk screening using the Patient Safety Screener [7].”
From Emergency department safety assessment and follow-up evaluation 2: an implementation trial to improve suicide prevention. (2020) · cites this paper as [7]
In ED-SAFE 1, the rise in screening almost doubled risk detection, from 2.9% to 5.7% of adults.
“such an increase in screening nearly doubled risk detection, rising from 2.9% to 5.7% of adults [7]”
From Emergency department safety assessment and follow-up evaluation 2: an implementation trial to improve suicide prevention. (2020) · cites this paper as [7]
Historically, many patients at risk for suicide in routine clinical care are not detected, and those detected often do not receive suicide-specific intervention.
“Historically, many patients with suicide risk are not detected during routine clinical care, and those who are often do not receive suicide-specific intervention.”
From Emergency department safety assessment and follow-up evaluation 2: an implementation trial to improve suicide prevention. (2020) · cites this paper as [7]
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Self-citationDarnell, D. A., Areán, P. A., Dorsey, S., Atkins, D. C., Tanana, M., Hirsch, T., Mooney, S. D., Boudreaux, E. D., & Comtois, K. A. (2021) · JMIR Research Protocols · doi:10.2196/33695 · Cited by 11 · see citing works
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Western Journal of Emergency Medicine
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Development and pilot study of simple suicide risk rulers for use in the emergency department
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Targeted HIV screening in the emergency department
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- Authors
- Boudreaux, E. D., Camargo, C. A., Arias, S. A., Sullivan, A. F., Allen, M. H., Goldstein, A. B., Manton, A. P., Espinola, J. A., & Miller, I. W.
- Affiliations
- University of Massachusetts Chan Medical School (US)
- Massachusetts General Hospital (US)
- Brown University (US)
- National Institutes of Health (US)
- Cape Cod Hospital (US)
- Corresponding author
- Boudreaux, Edwin D.
- ORCID
- Venue
- American Journal of Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2016-04
- Volume
- 50
- Issue
- 4
- Pages
- 445-453
- ISSN
- 0749-3797 (ISSN-L)
- PMC
- PMC4801719
- OpenAlex
- W2181951461
- Cited by
- 189
- References
- 23
- Citations by year
- 2026: 15 · 2025: 21 · 2024: 13 · 2023: 24 · 2022: 21 · 2021: 21 · 2020: 23 · 2019: 14 · 2018: 17 · 2017: 15 · 2016: 5
- FWCI
- 15.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (U01MH088278)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- suicide risk screening, emergency department, universal screening, suicide risk identification, intentional self-harm, suicidal ideation, suicide prevention
- MeSH terms
- Suicide Prevention, Adolescent, Adult, Aged, Emergency Service, Hospital, Feasibility Studies, Female, Humans, Male, Mass Screening, Middle Aged, Suicide, Attempted, Self-Injurious Behavior, Outcome Assessment, Health Care, Risk Assessment, Young Adult, Suicidal Ideation, Interrupted Time Series Analysis
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