The Department of Emergency Medicine is conducting a $12-million, multi-site study funded by the National Institutes of Mental Health aimed at improving suicide prevention in hospital emergency department patients.
Edwin Boudreaux, PhD, professor of emergency medicine, psychiatry and quantitative health sciences, is leading a team of colleagues conducting the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) trial, which is expected to enroll 1,400 participants over five years.
“We’re asking two main questions with this study: Does universal screening increase the detection of suicidality? And, can care for patients be improved to reduce attempted and completed suicides?” Dr. Boudreaux said.
There have been relatively few controlled trials that evaluate interventions to reduce suicidal behavior, despite the public health significance, Boudreaux said. He noted that the emergency department (ED) setting is well-suited for this type of research. In 2006, there were more than 500,000 ED visits related to intentional self-harm, and the rate of ED patients having active thoughts of suicide is estimated to range from 3 to 8 percent.
“We believe we may have an opportunity to impact suicide by connecting with patients while they’re in the ED,” said Boudreaux.
ED-SAFE will be conducted in three phases. The first phase will assess “treatment as usual” (TAU) for patients, which typically consists of evaluating suicidal risk only among those emergency department patients who have psychiatric risk factors, such as depression, suicidal thoughts or behavior, or substance abuse. Often these patients are put under observation while at the hospital and are evaluated by a mental health provider. While some may be referred to a mental health professional outside the hospital, few receive adequate follow-up care after they are discharged.
During the second phase of the study, a universal screening process will be tested in which all patients, regardless of whether they exhibit typical risk factors for suicide, will be screened for thoughts of suicide. The researchers will compare universal screening with TAU to determine how well each detects suicidal patients.
“People are familiar with the type of questions they’re routinely asked in doctor’s visits, such as whether they have pain or whether they smoke,” said Boudreaux. “Those questions help physicians screen for possible health risks and refer the patient to appropriate care. Applying that same model, we’re looking to see whether asking whether individuals have thought about killing themselves, or have had a past attempt, will help identify those at risk so we can intervene before they take any action.”
During the third phase, a more intensive intervention that includes screening, brief counseling, an evaluation by a mental health provider, referral to outpatient care and other components will be implemented. Patients will then receive follow-up phone counseling after their ED visit. The intensive intervention will be compared to TAU and to universal screening.
The study will be conducted at eight sites, selected to represent both broad geographic regions of the United States and patient demographics. These sites include: UMass Memorial (Marlborough Hospital), Memorial Hospital of Rhode Island, University of Colorado, Beth Israel Deaconess Medical Center in Boston, Maricopa Integrated Health in Phoenix, Ohio State University Medical Center, University of Arkansas Medical Center, and University of Nebraska Medical Center. The study will be coordinated jointly by investigators at UMass Medical School and the Emergency Medicine Network (EMNet). The principal investigator team includes Boudreaux; Carlos A. Camargo Jr., MD, PhD, of the Harvard School of Public Health; and Ivan Miller, PhD, of Brown University.