Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2017 Jun 1;74(6):563-570.
doi: 10.1001/jamapsychiatry.2017.0678.

Suicide Prevention in an Emergency Department Population: The ED-SAFE Study

Ivan W Miller  1 , Carlos A Camargo Jr  2 , Sarah A Arias  1 , Ashley F Sullivan  2 , Michael H Allen  3 , Amy B Goldstein  4 , Anne P Manton  5 , Janice A Espinola  2 , Richard Jones  6 , Kohei Hasegawa  2 , Edwin D Boudreaux  7 ; ED-SAFE Investigators
Affiliations
Clinical Trial

Suicide Prevention in an Emergency Department Population: The ED-SAFE Study

Ivan W Miller et al. JAMA Psychiatry. .

Abstract

Importance: Suicide is a leading cause of deaths in the United States. Although the emergency department (ED) is an opportune setting for initiating suicide prevention efforts, ED-initiated suicide prevention interventions remain underdeveloped.

Objective: To determine whether an ED-initiated intervention reduces subsequent suicidal behavior.

Design, setting, and participants: This multicenter study of 8 EDs in the United States enrolled adults with a recent suicide attempt or ideation and was composed of 3 sequential phases: (1) a treatment as usual (TAU) phase from August 2010 to December 2011, (2) a universal screening (screening) phase from September 2011 to December 2012, and (3) a universal screening plus intervention (intervention) phase from July 2012 to November 2013.

Interventions: Screening consisted of universal suicide risk screening. The intervention phase consisted of universal screening plus an intervention, which included secondary suicide risk screening by the ED physician, discharge resources, and post-ED telephone calls focused on reducing suicide risk.

Main outcomes and measures: The primary outcome was suicide attempts (nonfatal and fatal) over the 52-week follow-up period. The proportion and total number of attempts were analyzed.

Results: A total of 1376 participants were recruited, including 769 females (55.9%) with a median (interquartile range) age of 37 (26-47) years. A total of 288 participants (20.9%) made at least 1 suicide attempt, and there were 548 total suicide attempts among participants. There were no significant differences in risk reduction between the TAU and screening phases (23% vs 22%, respectively). However, compared with the TAU phase, patients in the intervention phase showed a 5% absolute reduction in suicide attempt risk (23% vs 18%), with a relative risk reduction of 20%. Participants in the intervention phase had 30% fewer total suicide attempts than participants in the TAU phase. Negative binomial regression analysis indicated that the participants in the intervention phase had significantly fewer total suicide attempts than participants in the TAU phase (incidence rate ratio, 0.72; 95% CI, 0.52-1.00; P = .05) but no differences between the TAU and screening phases (incidence rate ratio, 1.00; 95% CI, 0.71-1.41; P = .99).

Conclusions and relevance: Among at-risk patients in the ED, a combination of brief interventions administered both during and after the ED visit decreased post-ED suicidal behavior.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. CONSORT Diagram
Figure 2.
Figure 2.. Total Suicide Attempts per Participant by Phase
TAU indicates treatment as usual.
Figure 3.
Figure 3.. Proportion of Participants Who Did Not Make a Suicide Attempt Over Time
The screening phase (phase 2) vs the treatment as usual phase (phase 1): P = .56 by log-rank test. The intervention phase (phase 3) vs the treatment as usual phase (phase 1): P = .08 by log-rank test.
See this image and copyright information in PMC

Comment in

References

    1. Drapeau CW, McIntosh JL; American Association of Suicidology USA suicide: 2015 official final data. http://www.floridasuicideprevention.org/PDF/2015%20US%20Suicide%20Offici.... Accessed February 20, 2017.
    1. Brown GK, Ten Have T, Henriques GR, Xie SX, Hollander JE, Beck AT. Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. JAMA. 2005;294(5):563-570. - PubMed
    1. Linehan MM, Comtois KA, Murray AM, et al. . Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry. 2006;63(7):757-766. - PubMed
    1. Rudd MD, Bryan CJ, Wertenberger EG, et al. . Brief cognitive-behavioral therapy effects on post-treatment suicide attempts in a military sample: results of a randomized clinical trial with 2-year follow-up. Am J Psychiatry. 2015;172(5):441-449. - PubMed
    1. Tarrier N, Taylor K, Gooding P. Cognitive-behavioral interventions to reduce suicide behavior: a systematic review and meta-analysis. Behav Modif. 2008;32(1):77-108. - PubMed

MeSH terms