New Grant Aims to Identify and Reduce Suicide Among Emergency Department Patients

A new NIMH-funded grant aims to increase suicide detection and prevention efforts among patients who present with suicide risk factors in hospital emergency departments.

The Emergency Department Safety Assessment and Follow-up Evaluation (EDSAFE) trial will be coordinated by the Emergency Medicine Network (EMNet), which is based at Massachusetts General Hospital. The team of researchers will be led by Edwin D. Boudreaux, Ph.D., of the University of Massachusetts, Carlos A. Camargo, Jr., M.D., DrPH, of Massachusetts General Hospital and Harvard Medical School, and Ivan Miller, Ph.D., of Butler Hospital in Providence, RI. The project is expected to enroll nearly 1,420 participants over five years.

EDSAFE will be conducted in three phases. The first phase will assess treatment as usual (TAU) for patients. TAU typically consists of evaluating suicidal risk only among those emergency department patients who have psychiatric risk factors such as depression, suicidal thinking or behavior (ideation), or substance abuse. Often these patients are put under observation while at the hospital and are evaluated by a mental health provider. They also may be referred to a mental health professional outside the hospital, but few receive adequate follow-up care after they are discharged. During the second phase, 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 suicidal ideation. The researchers will compare universal screening with TAU to determine how well each detects suicidal patients.

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. The intensive intervention will be compared to TAU and to universal screening.

The study will be conducted at eight sites throughout the nation and is set to begin in June 2010.