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An Emergency Department Intervention for Linking Pediatric Suicidal Patients to Follow-Up Mental Health Treatment
Open accessAbstract
OBJECTIVE: Suicide is the third leading cause of death among adolescents. Many suicidal youths treated in emergency departments do not receive follow-up treatment as advocated by the National Strategy for Suicide Prevention. Two strategies for improving rates of follow-up treatment were compared. METHODS: In a randomized controlled trial, suicidal youths at two emergency departments (N=181; ages ten to 18) were individually assigned between April 2003 and August 2005 to one of two conditions: an enhanced mental health intervention involving a family-based cognitive-behavioral therapy session designed to increase motivation for follow-up treatment and safety, supplemented by care linkage telephone contacts after emergency department discharge, or usual emergency department care enhanced by provider education. Assessments were conducted at baseline and approximately two months after discharge from the emergency department or hospital. The primary outcome measure was rates of outpatient mental health treatment after discharge. RESULTS: Intervention patients were significantly more likely than usual care patients to attend outpatient treatment (92% versus 76%; p=.004). The intervention group also had significantly higher rates of psychotherapy (76% versus 49%; p=.001), combined psychotherapy and medication (58% versus 37%; p=.003), and psychotherapy visits (mean 5.3 versus 3.1; p=.003). Neither the emergency department intervention nor community outpatient treatment (in exploratory analyses) was significantly associated with improved clinical or functioning outcomes. CONCLUSIONS: Results support efficacy of the enhanced emergency department intervention for improving linkage to outpatient mental health treatment but underscore the need for improved community outpatient treatment to prevent suicide, suicide attempts, and poor clinical and functioning outcomes for suicidal youths treated in emergency departments.
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“SI was designated as a primary outcome in zero studies and designated as a secondary outcome in 3 studies.35,38,40”
From Safety Planning Interventions for Suicide Prevention in Children and Adolescents: A Systematic Review and Meta-Analysis (2025) · cites this paper as [35]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“In controlled trials with children and adolescents,35,38,39,40,42,43,44 control conditions were often vaguely defined and sometimes involved elements of safety planning to varying degrees, although results were consistent whether these studies were removed (Figure 2) or included (eFigure in Supplement 1).”
From Safety Planning Interventions for Suicide Prevention in Children and Adolescents: A Systematic Review and Meta-Analysis (2025) · cites this paper as [35]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
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“Based on study-level results, adolescents who received interventions that were family-based had lower rates of re-presentation44 and were more likely to be linked to outpatient mental health services after discharge35 compared with adolescents who received treatment as usual.”
From Safety Planning Interventions for Suicide Prevention in Children and Adolescents: A Systematic Review and Meta-Analysis (2025) · cites this paper as [35]
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“SRB was designated as a primary outcome in 1 study44 and a secondary outcome in 2 studies.35,38”
From Safety Planning Interventions for Suicide Prevention in Children and Adolescents: A Systematic Review and Meta-Analysis (2025) · cites this paper as [35]
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“SA was designated as a primary outcome in 1 study40 and a secondary outcome in 1 study.35”
From Safety Planning Interventions for Suicide Prevention in Children and Adolescents: A Systematic Review and Meta-Analysis (2025) · cites this paper as [35]
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“Only 3 studies35,42,44 had adequate-sized samples to compare treatment effects across groups; 2 of these studies35,44 used true randomization, and neither found significant between-group differences in suicide-related outcomes.”
From Safety Planning Interventions for Suicide Prevention in Children and Adolescents: A Systematic Review and Meta-Analysis (2025) · cites this paper as [35]
In the citing paper
“Asarnow and colleagues53 demonstrated that a brief family-based ED intervention, the Family Intervention for Suicide Prevention (FISP), could effectively link youth and parents to care and this intervention was effectively delivered in the ED setting in 80.9% of patients54.”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [53]
In the citing paper
“FISP was tested in a randomized controlled trial in which suicidal youths at two EDs (N=181; aged 10-18) were individually randomized to 1) Usual ED Care enhanced by provider education (UC); or 2) FISP, supplemented by care linkage telephone contacts after discharge. Intervention patients were significantly more likely to attend outpatient treatment compared to UC patients (92.1% vs 76.2%, p=0.004”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [53]
In the citing paper
“The intervention group also had a significantly higher rate of psychotherapy, combined psychotherapy/medication, and more psychotherapy visits”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [53]
In the citing paper
“FISP, also included as an evidence-based intervention by SPRC/AFSP , is an enhanced mental health intervention involving a family-based CBT session in the ED designed to increase motivation for follow-up treatment, support, coping, and safety.53”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [53]
In the citing paper
“but no significant effects on suicidality or other clinical/functioning outcomes (exploratory analyses).53”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [53]
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Metadata
- Authors
- Asarnow, J. R., Baraff, L. J., Berk, M., Grob, C. S., Devich-Navarro, M., Suddath, R., Piacentini, J. C., Rotheram-Borus, M. J., Cohen, D., & Tang, L.
- Affiliations
- University of California, Los Angeles (US)
- Harbor–UCLA Medical Center (US)
- Santa Monica College (US)
- Dr. Suddath, Dr. Piacentini, Dr. Rotheram-Borus, and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, UCLA.
- Johns Hopkins University (US)
- Venue
- Psychiatric Services
- Published
- 2011-11
- Volume
- 62
- Issue
- 11
- Pages
- 1303-1309
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- PMC
- PMC3251923
- OpenAlex
- W2170748745
- Cited by
- 251
- References
- 41
- Citations by year
- 2026: 15 · 2025: 20 · 2024: 18 · 2023: 24 · 2022: 16 · 2021: 28 · 2020: 19 · 2019: 20 · 2018: 11 · 2017: 15 · 2016: 21 · 2015: 9 · 2014: 19 · 2013: 12 · 2012: 4
- FWCI
- 12.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Public Health Service (CCR921708)
- National Institute of Mental Health (R34MH078082, P30MH082760, R01MH082856)
- 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
- adolescent suicide, suicide prevention, emergency department care, provider education, suicide attempts
- MeSH terms
- Suicide Prevention, Adolescent, Ambulatory Care, Child, Community Mental Health Services, Depressive Disorder, Emergency Service, Hospital, Family Therapy, Female, Humans, Male, Patient Acceptance of Health Care, Patient Discharge, Pilot Projects, Regression Analysis, Stress Disorders, Post-Traumatic, Suicide, Suicide, Attempted, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult, Suicidal Ideation
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