September 13, 2012
Emergency Department Suicide Prevention in Youth
NAMHC Concept Clearance
Amy Goldstein, Ph.D.
Chief, Preventive Interventions Research Program
Division of Services and Intervention Research (DSIR)
Suicide continues to be the third leading cause of death among youth aged 10-24 years old. Emergency Medicine Department (ED) practitioners are responsible for risk assessment, discharge, and referral of high risk suicidal individuals, yet no evidence-based standards exist for these practices. This initiative aims to support research to improve identification, evaluation, and appropriate referral by ED staff of youth at risk for suicide. This research will lay the foundation for future efforts to match appropriate interventions to at-risk youth, increasing intervention effectiveness and improving long-term clinical outcomes.
Research that will contribute to the reduction of suicide deaths, attempts, and ideation continues to be a major focus of NIMH. Substantial advances have been achieved in understanding suicide risk factors, testing interventions designed to reduce re-attempts, and creating developmentally appropriate interventions to treat youth who are suicidal. However, there have been fewer studies conducted with respect to screening, risk stratification, and management of suicidality, particularly within the ED setting. When considering the range of treatments for youth considered at risk—from brief interventions, to a course of psychotherapy or medication, or expensive inpatient hospitalization—there is little empirical evidence to guide risk evaluation and referral to appropriate interventions. In 2009, the NIMH funded the ED Safety Assessment and Follow-up Evaluation (ED-SAFE) trial as an effort to develop the evidence base for effective suicide screening and case management for adults who present for emergency medical care. The proposed initiative aims to build upon the findings from this research by stimulating development and validation of screening tools for reliably characterizing suicide risk status among youth who present for emergency medical care. Developing such tools would meet a critical need of ED staff members who currently lack practical and effective strategies to screen, triage, and make treatment decisions for at-risk youth.