Emergency departments are underutilized sites for suicide prevention
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The Joint Commission recommends universal suicide risk screening in emergency departments because emergency department patients have an overrepresentation of suicide risk.
“Universal screening for suicide risk in the emergency department entails screening every patient regardless of presenting complaint and is a practice recommended by the Joint Commission [11] due to an overrepresentation of suicide risk in emergency department patients [22–24].”
From Emergency department safety assessment and follow-up evaluation 2: an implementation trial to improve suicide prevention. (2020) · cites this paper as [23]
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MethodScreening Youth for Suicide Risk in Medical Settings
Horowitz, L. M., Bridge, J. A., Pao, M., & Boudreaux, E. D. (2014) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2014.06.002 · Cited by 70 · see citing works
Cultural context is crucial in suicide research and prevention
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“Presentation to an ED often marks the first instance in which a young person discloses their self-harm [14], and as such presents an opportunity to engage those at-risk and provide therapeutic interventions and/or link them to appropriate longer term supports [15].”
BackgroundChild Psychiatric Emergencies: Updates on Trends, Clinical Care, and Practice Challenges
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Emergency Department Recognition of Mental Disorders and Short-Term Outcome of Deliberate Self-Harm
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“, somatic and/or psychiatric, social, or age-related issues, making SI and SA assessment difficult [1].”
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“Findings such as these are useful for meeting the demands of improved screening, interventions, treatment, and follow-up with suicidal ED patients (19).”
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Hospital Emergency Department Lethal Means Counseling for Suicidal Patients
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“Of those who do, a substantial proportion will have visited the ED for suicidality the year before they die [23-25].”
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“The 24/7 availability and flexible health structure of EDs may represent the most convenient way for many individuals who have attempted suicide or are experiencing suicidal ideation to make contact with health professionals (Larkin and Beautrais, 2010; Ting et al., 2012).”
BackgroundAdolescent Suicidality: Who Will Ideate, Who Will Act?
Miller, T. R., & Taylor, D. M. (2005) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.2005.35.4.425 · Cited by 41 · see citing works
Adolescent Admissions to Emergency Departments for Self-Injurious Thoughts and Behaviors
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Community mental health care after self-harm: A retrospective cohort study
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“Presentation to hospital for treatment of self-inflicted injuries or poisoning therefore presents an opportunity to initiate mental health treatment in hospital and to create pathways for ongoing care in the community (Larkin and Beautrais, 2010).”
BackgroundBoudreaux, E. D., Haskins, B. L., Larkin, C., Pelletier, L., Johnson, S. A., Stanley, B., Brown, G., Mattocks, K., & Ma, Y. (2020) · Contemporary Clinical Trials · doi:10.1016/j.cct.2020.106075 · Cited by 24 · see citing works
Emergency Department Presentations and Youth Suicide: A Case-Control Study
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“These results are consistent with previous research, healthcare professionals are likely to be exposed to suicide because of their occupations (Larkin & Beautrais, 2010).”
ResultSaving Lives: Recognizing and Intervening with Youth at Risk for Suicide
Arango, A., Gipson, P. Y., Votta, J. G., & King, C. A. (2021) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-081219-103740 · Cited by 28 · see citing works
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“ED settings in particular treat patients with many risk factors for suicide beyond psychiatric and medical illnesses, including alcohol and drug abuse, physical injury, and interpersonal violence [9].”
BackgroundMethodPredictors of emergency department visits for suicidal ideation and suicide attempt
Gentil, L., Huỳnh, C., Grenier, G., & Fleury, M. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112805 · Cited by 27 · see citing works
Caring E‐mails for Military and Veteran Suicide Prevention: A Randomized Controlled Trial
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Bullying and Suicide Risk Among Pediatric Emergency Department Patients
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A Trauma-Informed Approach to Youth Suicide Prevention and Intervention
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“…rates of suicide attempts are higher among adolescents than for any other age group and are associated with psychiatric and substance use problems, emergency psychiatric services, and increased risk of subsequent repeat suicidal behavior (Goldston et al., 2015, 2016; Larkin & Beautrais, 2010).”
BackgroundKvaran, R. B., Gunnarsdottir, O. S., Kristbjornsdottir, A., Valdimarsdottir, U. A., & Rafnsson, V. (2015) · BMC Public Health · doi:10.1186/s12889-015-1544-5 · Cited by 22 · see citing works
“Screening for suicide in the ED has been suggested and investigated [8,10,11].”
BackgroundGuardia, A. C. L., Cramer, R. J., Brubaker, M. D., & Long, M. M. (2018) · Community Mental Health Journal · doi:10.1007/s10597-018-0314-0 · Cited by 23 · see citing works
Ballard, E. D., Horowitz, L. M., Jobes, D. A., Wagner, B. M., Pao, M., & Teach, S. J. (2013) · Pediatric Emergency Care · doi:10.1097/pec.0b013e3182a5cba6 · Cited by 23 · see citing works
“Prospective studies with larger and more diverse samples could uncover trends in hospitalization and, in particular, repeated ED visits, which strain already overburdened health care resources.(17,22,23) Of note, there were few differences in responses to suicide screening questions between the 2 age groups.”
BackgroundWilson, M. P., Waliski, A., & Thompson, R. G. (2022) · Psychiatric Services · doi:10.1176/appi.ps.202100561 · Cited by 22 · see citing works
Kuramoto-Crawford, S. J., Spies, E., & Davies-Cole, J. O. A. (2017) · Public Health Reports · doi:10.1177/0033354917706933 · Cited by 22 · see citing works
DeVylder, J., Ryan, T. C., Cwik, M. F., Jay, S. Y., Wilson, M. E., Goldstein, M. A., & Wilcox, H. C. (2019) · Psychiatric Services · doi:10.1176/appi.ps.201900290 · Cited by 22 · see citing works
van Landschoot, R., Portzky, G., & van Heeringen, K. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14030304 · Cited by 20 · see citing works
“They can be among the first to screen and intervene for suicide risk as they may be in close contact with suicidal individuals and therefore have the opportunity to interrupt an ongoing suicidal process [5,6].”
BackgroundChakravarthy, B., Hoonpongsimanont, W., Anderson, C., Habicht, M., Bruckner, T. A., & Lotfipour, S. (2014) · Western Journal of Emergency Medicine · doi:10.5811/westjem.2013.11.13172 · Cited by 19 · see citing works
Zarska, A., Barnicot, K., Lavelle, M., Dorey, T., & McCabe, R. (2022) · Archives of Suicide Research · doi:10.1080/13811118.2022.2071660 · Cited by 18 · see citing works
“As such, the ED can be the only contact with the healthcare system for people who self-harm, representing a vital opportunity for intervention and suicide prevention (Betz et al., 2016; Larkin & Beautrais, 2010).”
BackgroundInfluentialExamining the impact of emergency care settings on suicidal patients: A call to action
Guzmán, E. M., Tezanos, K. M., Chang, B., & Cha, C. B. (2018) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2018.07.004 · Cited by 19 · see citing works
Vaughn, L. M., Sunny, C. E., Lindquist-Grantz, R., King, C. A., Brent, D. A., Boyd, S. D., & Grupp‐Phelan, J. (2018) · Archives of Suicide Research · doi:10.1080/13811118.2018.1541034 · Cited by 18 · see citing works
“For 1.5 million children in the United States, the Emergency Department (ED)1 is the only source of medical care (Wilson & Klein, 2000), making it a vital, but historically underutilized (Larkin & Beautrais, 2010) setting for suicide prevention.”
BackgroundInfluentialSteeg, S., Carr, M., Emsley, R., Hawton, K. E., Waters, K., Bickley, H., Ness, J., Geulayov, G., & Kapur, N. (2018) · PLoS ONE · doi:10.1371/journal.pone.0204670 · Cited by 17 · see citing works
“Given the high risk of suicide after self-harm, particularly in the early aftermath, EDs are a key potential suicide prevention site [13].”
BackgroundTsujii, N., Shirakawa, O., Atsushi, N., Yonemoto, N., Kawanishi, C., Yamamoto, K., Sugimoto, T., & Hirayasu, Y. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.04.037 · Cited by 17 · see citing works
Ballard, E. D., Tingey, L., Lee, A., Suttle, R., Barlow, A., & Cwik, M. F. (2014) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2013.11.015 · Cited by 13 · see citing works
“Consequently, screening in ED settings may be a critical strategy to increase identification of individuals at risk for suicide and decrease suicide attempts and deaths [6,7].”
BackgroundAn Emergency Department‐Initiated Intervention to Lower Relapse Risk after Attempted Suicide
Martínez‐Alés, G., Jiménez‐Sola, E., Román‐Mazuecos, E., Sánchez-Castro, P., de Dios, C., Vega, B. R., & Bravo‐Ortiz, M. F. (2019) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12542 · Cited by 13 · see citing works
Bridge, J. A., Olfson, M., Fontanella, C. A., & Marcus, S. C. (2018) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12377 · Cited by 11 · see citing works
“…to evaluate current and past psychiatric diagnoses and treatment, psychosocial stressors, and other signs and symptoms that could influence suicide risk (Jacobs et al., 2003), which may lead to potentially life-saving referrals for outpatient mental health care (Larkin & Beautrais, 2010).”
BackgroundLes soins médicaux de jeunes hommes et de jeunes femmes qui décèdent par suicide
Rhodes, A. E., Boyle, M. H., Bridge, J. A., Sinyor, M., Katz, L. Y., Bennett, K., Newton, A. S., Links, P. S., Tonmyr, L., Skinner, R., et al. (2018) · The Canadian Journal of Psychiatry · doi:10.1177/0706743717741060 · Cited by 12 · see citing works
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“Many suicide attempters present themselves to the ED making it therefore a plausible place to prevent reenactment of suicidal behavior and the startup point for secondary prevention (Larkin & Beautrais, 2010).”
BackgroundSuicidality and mood disorders in psychiatric emergency patients: Results from SBQ‐R
Brousseau‐Paradis, C., LESAGE, A. D., Larue, C., Labelle, R. J., Giguère, C., & Rassy, J. (2023) · International Journal of Mental Health Nursing · doi:10.1111/inm.13161 · Cited by 12 · see citing works
Factors Associated with Parental Satisfaction with a Pediatric Crisis Clinic (PCC).
Lee, J. C., & Korczak, D. J. (2014) · Europe PMC (PubMed Central) · Cited by 11 · see citing works
Bridge, J. A., Horowitz, L. M., & Campo, J. V. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.0677 · Cited by 11 · see citing works
Buykx, P., Ritter, A. J., LOXLEY, W. M., & Dietze, P. (2011) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-011-9338-1 · Cited by 11 · see citing works
“The Emergency Department (ED) has been identified as a critical link in interventions for those at risk of suicide ( Larkin and Beautrais 2010; Mehlum and Ramberg 2010).”
BackgroundChartier, G., Lam, F., Bergmans, Y., Lofchy, J., Bolton, J. M., Klonsky, E. D., Zaheer, J., & Kealy, D. (2023) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000725 · Cited by 10 · see citing works
Firearm suicide mortality among emergency department patients with physical health problems
Goldman-Mellor, S. J., Hall, C., Cerdá, M., & Bhat, H. (2020) · Annals of Epidemiology · doi:10.1016/j.annepidem.2020.09.007 · Cited by 10 · see citing works
“EDs are a promising healthcare setting for reducing population suicide risk (21,35), as ED patients have higher concentrations of suicide risk than outpatients (36-38), comprise a larger proportion and broader spectrum of the population than hospitalized patients (39,40), and are already the site of effective interven…”
BackgroundCharacteristics of Pediatric Psychiatric Emergency Population in a Mental Health Hospital
Mutlu, C., Kılıçoğlu, A. G., Güneş, H., Adaletli, H., Metin, H., Bahalı, M. K., İpek, H., & Üneri, Ö. Ş. (2015) · Eurasian Journal of Emergency Medicine · doi:10.5152/eajem.2015.71354 · Cited by 10 · see citing works
Suicide in Asia: Epidemiology, Risk Factors, and Prevention
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Therapeutic Alliance and the Therapist
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Innes, S. I., Steel, P., Jack, E., Brann, P., & Hope, J. (2024) · International Journal of Mental Health Nursing · doi:10.1111/inm.13456 · Cited by 9 · see citing works
Coutinho, A. P. D. O., Henriques, M. I. R. S., Rothes, I., Zortea, T. C., Santos, J. C., & Cuijpers, P. J. (2021) · Systematic Reviews · doi:10.1186/s13643-021-01609-5 · Cited by 8 · see citing works
“Therefore, EDs should not be undervalued sites to promote suicide prevention; rather, they should be regarded as a useful scenario for initiating the implementation of effective interventions for those who enter the ED due to suicide attempts [17, 20].”
BackgroundA randomized, controlled trial of the safety planning intervention: Research design and methods
Boudreaux, E. D., Stanley, B., Green, K. L., Galfalvy, H., & Brown, G. K. (2021) · Contemporary Clinical Trials · doi:10.1016/j.cct.2021.106291 · Cited by 9 · see citing works
Bowden, C. F., Worsley, D., Esposito, J. M., Cutler, G. J., & Doupnik, S. K. (2022) · Journal of the American College of Emergency Physicians Open · doi:10.1002/emp2.12839 · Cited by 10 · see citing works
“27,28 The context scale has 23 items and each item is assessed using a 5-point Likert scale (ranging from strongly disagree (1) to strongly agree (5)).”
BackgroundMethodLaw, Y. W., Yip, P. S. F., Lai, C. C. S., Kwok, C.-L., Wong, P. W. C., Liu, K.-S., Ng, P. W. L., Liao, C. W. M., & Wong, T. (2016) · Crisis · doi:10.1027/0227-5910/a000393 · Cited by 9 · see citing works
Michaud, L., Berva, S., Ostertag, L., Costanza, A., der Vaeren, B. V., Dorogi, Y., Saillant, S., Golay, P., & Morandi, S. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114810 · Cited by 8 · see citing works
“Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres https://doi.org/10.1016/j.psychres.2022.114810 Received 13 July 2022; Received in revised form 18 August 2022; Accepted 21 August 2022 Psychiatry Research 317 (2022) 114810 Health Organization 2016) are the…”
InfluentialHeilbron, N., Goldston, D. B., Walrath, C., Rodi, M., & McKeon, R. (2012) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12004 · Cited by 8 · see citing works
Adeosun, I. I., Adegbohun, A. A., Jeje, O. O., Oyekunle, O. O., & Omoniyi, M. O. (2014) · Emergency Medicine International · doi:10.1155/2014/479081 · Cited by 8 · see citing works
“The finding is consistent with previous reports in the literature [25, 28].”
BackgroundResultCode 100: a study on suicidal behavior in public places.
López‐Castromán, J., Méndez-Bustos, P., Pérez-Fominaya, M., Villoria, L., Zamorano, M. J., Molina, C. A., Lorie, A. V., Tabuenca, T. P., Casado-Florez, I., & Baca‐García, E. (2015) · PubMed · Cited by 8 · see citing works
Parra, J. G., (CTS-945)., G. A. D. I. P. (., Málaga, E. I. I., Martínez-García, A. I., Guillén-Benítez, C., Zamudio, S. C., Jiménez-Hernández, M., Moreno‐Küstner, B., Guadalhorce., U. D. G. C. D. L. D. D. C. C. Y. U. D. D. S. M.-C., & Departamento de Personalidad, E. Y. T. P. U. D. M. (2016) · Salud Mental · doi:10.17711/sm.0185-3325.2016.033 · Cited by 8 · see citing works
Rhodes, A. E., Bethell, J., Newton, A. S., Antony, J., Tonmyr, L., Bhanji, F., Chaulk, D., Curtis, S. J., Gouin, S., Joubert, G. I., et al. (2012) · Pediatric Emergency Care · doi:10.1097/pec.0b013e3182712981 · Cited by 7 · see citing works
“These latter findings are supported by some empirical data; for example, a study of 32 hospitals in England found large differences between institutions in aspects of suicide-related behavior management and specifically for inpatient admissions, inpatient psychiatric admissions, and referrals for specialist mental hea…”
BackgroundInfluentialMcManus, M. C., Cramer, R. J., Boshier, M., Akpinar‐Elci, M., & Lunen, B. L. V. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15010129 · Cited by 7 · see citing works
“Scholars have even called for training and empirical testing on the applicability of gatekeeper training for overall mental illness so that ED staff can recognize these encounters [66].”
BackgroundEmergency department psychiatric holds are linked to increased emergency department violence
Costumbrado, J., Nikroo, N., Ge, S., & Guldner, G. (2021) · Ethics Medicine and Public Health · doi:10.1016/j.jemep.2021.100731 · Cited by 7 · see citing works
Poremski, D., Lim, X. Y., Kunjithapatham, G., Koh, D., Alexander, M., & Lee, C. (2016) · International Journal of Mental Health Nursing · doi:10.1111/inm.12248 · Cited by 7 · see citing works
Dimeff, L. A., Jobes, D. A., Tyndal, T., Zhang, I., Stefan, S., Kako, N., Lawrence, H. R., & Ilac, M. (2021) · Archives of Suicide Research · doi:10.1080/13811118.2021.1984347 · Cited by 7 · see citing works
“Of those who do die by suicide, a significant number will have visited the ED for suicidality the year before their death (Gairin, House, & Owens, 2003; Larkin & Beautrais, 2010; Wilson & Klein, 2000).”
BackgroundPsychiatric Consultation and Referral of Persons Who Have Attempted Suicide
Roelands, M., Deschepper, R., & Bilsen, J. J. R. (2017) · Crisis · doi:10.1027/0227-5910/a000445 · Cited by 7 · see citing works
Powell, D. S., Lanzillo, E. C., Jay, S. Y., Tanenbaum, M. T., Bridge, J. A., Wharff, E. A., Ballard, E. D., Pao, M., & Horowitz, L. M. (2020) · Pediatric Emergency Care · doi:10.1097/pec.0000000000002234 · Cited by 6 · see citing works
Geoffrion, S., Nolet, K., Giguère, C., Lecomte, T., Potvin, S., LUPIEN, S. J., & Marin, M. (2021) · The Canadian Journal of Psychiatry · doi:10.1177/07067437211018793 · Cited by 6 · see citing works
Firearms Access among Pediatric Patients at Risk for Suicide
Lowry, N. J., Stanley, I. H., Mournet, A. M., Wharff, E. A., Sullivant, S. A., Teach, S. J., Pao, M., Horowitz, L. M., & Bridge, J. A. (2022) · Archives of Suicide Research · doi:10.1080/13811118.2022.2106924 · Cited by 6 · see citing works
“Pediatric medical settings represent an important venue for detecting at risk youth and ensuring that their homes are kept safe (Horowitz, Bridge, Pao, & Boudreaux, 2014; King, O’Mara, Hayward, & Cunningham, 2009; Larkin & Beautrais, 2010).”
BackgroundPham, T. T. L., O’Brien, K., Liu, S., Gibson, K., & Berecki‐Gisolf, J. (2023) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674231177237 · Cited by 6 · see citing works
“Although hospital presentation for self-harm is an opportunity for psychological management and other self-harm interventions (Larkin and Beautrais, 2010), only around 50% of CALD and non-CALD patients, who had not previously used clinical mental health services before self-harm, used them after…”
BackgroundMortier, P., Amigo, F., Bhargav, M., Conde, S., Ferrer, M., Flygare, O., Kizilaslan, B., Moreno, L. L., Leis, Á., Mayer, M. Á., et al. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05659-6 · Cited by 8 · see citing works
“EDs play a pivotal role in the care for people with self-harm [14, 15] as they often represent the first medical contact after self-harm and can offer specialized risk assessment and treatment referral.”
BackgroundEarly Intervention for Self‐Harm and Suicidality
Steeg, S., Cooper, J., & Kapur, N. (2014) · Early Intervention in Psychiatry · doi:10.1002/9781118557174.ch20 · Cited by 6 · see citing works
Ahn, E., Kim, J. Y., Moon, S., Ko, Y., Cho, H., Park, J.-H., Song, J. H., Kim, H. N., Jee, J. Y., & Han, R. Y. (2019) · Hong Kong Journal of Emergency Medicine · doi:10.1177/1024907918822255 · Cited by 6 · see citing works
Chronic substance use and self-harm in a primary health care setting
Breet, E., Bantjes, J. R., & Lewis, I. (2018) · African Journal of Primary Health Care & Family Medicine · doi:10.4102/phcfm.v10i1.1544 · Cited by 5 · see citing works
Suicide Prevention Interventions in the Emergency Department: A Scoping Review
Jensen, M. V., Gallagher, K., O’Driscoll, M., Østervang, C., Christiansen, E., & Stenager, E. N. (2025) · Journal of Emergency Nursing · doi:10.1016/j.jen.2025.05.002 · Cited by 4 · see citing works
Narita, K., Yonemoto, N., Kawashima, Y., Takai, M., Matsuo, M., Hirayasu, Y., & Kawanishi, C. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.11.036 · Cited by 4 · see citing works
Zhou, E., DeCou, C. R., Stuber, J., Rowhani‐Rahbar, A., Kume, K., & Rivara, F. P. (2019) · Archives of Suicide Research · doi:10.1080/13811118.2019.1635932 · Cited by 4 · see citing works
“In many cases, EDs are the only facilities that initially evaluate patients with suicide ideation or suicide attempt (Larkin & Beautrais, 2010; Stanley et al., 2018).”
BackgroundHallford, D. J., Wallman, E. J., Kaplan, R. A., & Melvin, G. A. (2026) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph23060790 · Cited by 3 · see citing works
“Additionally, these predictors are interrelated, with SI constituting a prominent reason for psychiatric hospitalisation [2,3], and the presence of SI associated with an increased number of lifetime suicide attempts [4,5].”
- Authors
- Larkin, G. L., & Beautrais, A. L.
- Affiliations
- Yale University (US)
- ORCID
- Larkin, Gregory Luke
- Venue
- Crisis
- Publisher
- Hogrefe Publishing Group
- Published
- 2010-01
- Volume
- 31
- Issue
- 1
- Pages
- 1-6
- ISSN
- 0227-5910 (ISSN-L)
- 2151-2396
- OpenAlex
- W2119346643
- Cited by
- 133
- References
- 48
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 7 · 2023: 8 · 2022: 8 · 2021: 14 · 2020: 10 · 2019: 8 · 2018: 10 · 2017: 12 · 2016: 11 · 2015: 10 · 2014: 10 · 2013: 6 · 2012: 5
- FWCI
- 5.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Crisis (publishedVersion)
- PubMed (publishedVersion)
- 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 prevention, emergency department, underutilization, emergency department visits, suicide risk assessment
- MeSH terms
- Suicide Prevention, Combined Modality Therapy, Emergency Service, Hospital, Health Services Accessibility, Health Services Needs and Demand, Humans, Mass Screening, Patient Education as Topic, Referral and Consultation, Suicide, Suicide, Attempted, Risk Assessment, Secondary Prevention, Suicidal Ideation
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