A randomized controlled trial to engage in care of adolescent emergency department patients with mental health problems that increase suicide risk.
Abstract
BACKGROUND: In pediatric emergency departments (EDs), adolescents at risk for suicide often escape detection and successful referral for outpatient mental health care. OBJECTIVE: This study aimed to assess the effectiveness of a brief, ED-based mental health service engagement intervention to increase linkage to outpatient mental health services. DESIGN/METHODS: Adolescents presenting to a pediatric ED who were not currently receiving mental health services were screened for suicide-related risk factors (Columbia Suicide Scale). If positive, youths were then screened for impairment, alcohol use, and depression. Those screening positive on the Columbia Suicide Scale and the alcohol, impairment, or depression screen were randomly assigned to the intervention (short motivational interview, barrier reduction, outpatient appointment established, reminders before scheduled appointment) or standard referral (telephone number for a mental health provider). Study groups were compared with respect to screen acceptability and outpatient mental health care linkage and change in depression symptoms at 60 days after the index ED visit. RESULTS: A total of 204 families were enrolled. Overall, 24 adolescents (12%) screened positive for suicide risk factors and were randomized to the intervention (n = 11) or standard referral (n = 13) groups. The groups did not significantly differ on several measures of screen acceptability. As compared with the standard referral group (15.4%), the intervention group (63.6%) was significantly more likely to attend a mental health appointment during the follow-up period (Fisher exact test, P = 0.03). There was also a nonsignificant trend toward greater improvement of depressive symptoms in the intervention than standard referral group (t = 1.79, df = 18, P = 0.09). CONCLUSIONS: When adolescents are identified in the ED with previously unrecognized mental health problems that increase suicide risk, a brief motivational and barrier-reducing intervention improves linkage to outpatient mental health services.
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MI is an evidence-based, collaborative counseling technique that explores intrinsic motivation and ambivalence.
“MI is an evidence-based, collaborative counseling technique, exploring intrinsic motivation and ambivalence.28,29”
Previous studies have shown that 2-day training courses were sufficient to improve use of MI methods compared with TAU.
“Finally, previous studies have shown that 2-day training courses were sufficient to improve use of MI methods compared with TAU29,47,48,49,70 and we aimed at a realistic approach.”
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]”
Six studies (42.9%) assessed depression.
“and 6 (42.9%) examined depression as an outcome.15,16,[19][20][21][22]”
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”
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- Authors
- Grupp-Phelan, J., McGuire, L., Husky, M. M., & Olfson, M.
- Affiliations
- AmeriCares (US)
- Université de Bordeaux (FR)
- Columbia University Irving Medical Center (US)
- Venue
- Pediatric Emergency Care
- Published
- 2012-12
- Volume
- 28
- Issue
- 12
- Pages
- 1263-1268
- ISSN
- 0749-5161 (ISSN-L)
- OpenAlex
- W2071330588
- Cited by
- 55
- References
- 30
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 8 · 2023: 9 · 2022: 4 · 2021: 8 · 2020: 2 · 2019: 4 · 2018: 3 · 2017: 2 · 2016: 3 · 2015: 2 · 2014: 1 · 2013: 3
- FWCI
- 2.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pediatric Emergency Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR000077)
- National Center for Advancing Translational Sciences
- 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
- adolescent suicide risk, pediatric emergency department, motivational interviewing, depression screening, alcohol screening, appointment reminders, suicide prevention
- MeSH terms
- Academic Medical Centers, Suicide Prevention, Adolescent, Adolescent Behavior, Psychology, Adolescent, Alcoholism, Appointments and Schedules, Mental Disorders, Child, Depression, Emergency Service, Hospital, Emergency Services, Psychiatric, Female, Follow-Up Studies, Hospitals, Pediatric, Hospitals, Urban, Humans, Interview, Psychological, Male, Mass Screening, Mental Health Services, Motivation, Ohio, Patient Acceptance of Health Care, Pilot Projects, Prospective Studies, Referral and Consultation, Risk, Risk Factors, Suicide
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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