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Cited by 21Suicide and Self-Harm StudiesPsychiatric care and mental health servicesEmergency and Acute Care Studies

Predictive utility of an emergency department decision support tool in patients with active suicidal ideation.

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Boudreaux, Edwin D., Larkin, Celine, Kini, Nisha, Capoccia, Lisa, Allen, Michael H., Goldstein Grumet, Julie, Silverman, Morton M., McKeon, Richard +4 more·2018·Psychological Services
DOI 10.1037/ser0000236PMC PMC6082179
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Abstract

Emergency department (ED) clinicians routinely decide the disposition of patients with suicidal ideation, with potential consequences for patient safety, liability, and system costs and resources. An expert consensus panel recently created a 6-item decision support tool for patients with passive or active suicidal ideation. Individuals scoring a 0 (exhibiting none of the tool's 6 items) are considered "lower risk" and suitable for discharge, while those with non-0 scores are considered "elevated risk" and should receive further evaluation. The current study tested the predictive utility of this tool using existing data from the Emergency Department Safety Assessment and Follow-up Evaluation. ED patients with active suicide ideation (n = 1368) were followed for 12 months after an index visit using telephone assessment and medical chart review. About 1 in 5 patients had attempted suicide during follow-up. Because of the frequency of serious warning signs and risk factors in this population, only three patients met tool criteria for "lower risk" at baseline. The tool had perfect sensitivity, but exceptionally low specificity, in predicting suicidal behavior within 6 weeks and 12 months. In logistic regression analyses, several tool items were significantly associated with suicidal behavior within 6 weeks (suicide plan, past attempt) and 12 months (suicide plan, past attempt, suicide intent, significant mental health condition, irritability/agitation/aggression). Although the tool did not perform well as a binary instrument among those with active suicidal ideation, having a suicide plan identified almost all attempters while suicide plan and past attempt identified over four-fifths of near-term attempts. (PsycINFO Database Record

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  • The EDSAFE/SAMSHA decision support tool's two items, having thought of a suicidal plan and having a history of a past attempt, both showed very high sensitivity (86.2-94.5%) for predicting a suicide attempt within the subsequent 6 weeks, but with low specificity (15.0-29.7%); taken together, these two items predicted 83% of all suicide attempts within 6 weeks.

    “Two items, having thought of a suicidal plan and having a history of a past attempt, both showed very high sensitivity (86.2 -94.5%) for predicting a suicide attempt within the subsequent 6 weeks, but with low sensitivity (15.0 -29.7%). Taken together, these two items predicted 83% of all suicide attempts within 6 weeks 214 .”

    From Suicide and suicide risk (2019) · cites this paper as [214]

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Authors
Boudreaux, E. D., Larkin, C., Kini, N., Capoccia, L., Allen, M. H., Goldstein Grumet, J., Silverman, M. M., McKeon, R., Barton, B., Miller, I., Formica, S. W., & Camargo, C. A.
Affiliations
  • University of Massachusetts Chan Medical School (US)
  • Education Development Center (US)
  • University of Colorado Anschutz (US)
  • Substance Abuse and Mental Health Services Administration (US)
  • Brown University (US)
  • Social Science Research and Evaluation (US)
  • Harvard University (US)
ORCID
Venue
Psychological Services
Publisher
American Psychological Association (APA)
Published
2018-08
Volume
15
Issue
3
Pages
270-278
ISSN
  • 1541-1559 (ISSN-L)
  • 1939-148X
DOI
10.1037/ser0000236
PMC
PMC6082179
OpenAlex
W2887057603
Cited by
21
References
21
Citations by year
2026: 2 · 2025: 2 · 2024: 1 · 2023: 1 · 2021: 4 · 2020: 7 · 2019: 3 · 2018: 1
FWCI
4.40
Type
journal article
Language
en
Open access
Locations
  • Psychological Services (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship@UMassChan (submittedVersion)
Funders
  • Brown University
  • University of Nebraska Medical Center
  • Ohio State University
  • National Institutes of Health (UL1TR000170)
  • National Institute of Mental Health (U01MH088278)
  • National Center for Advancing Translational Sciences
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
Keywords
suicidal ideation, suicide risk assessment, suicide attempt prediction, suicide planning, suicidal intent, emergency department disposition, patient safety
MeSH terms
Suicide Prevention, Decision Support Techniques, Emergency Service, Hospital, Humans, Risk Factors, Suicide, Attempted, Risk Assessment, Suicidal Ideation

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