Cord-blood levels of 25(OH)D had inverse associations with risk of respiratory infection and childhood wheezing but no association with incident asthma.
Importance
Suicide is a leading cause of deaths in the U.S. Although the emergency department (ED) is an opportune setting for initiating suicide prevention efforts, ED-initiated suicide prevention interventions remain underdeveloped.
Objective
To determine if an ED-initiated intervention reduces subsequent suicidal behavior.
Design
This multicenter study was composed of three sequential phases: 1) Treatment as Usual (TAU) (August 2010–December 2011), 2) Universal Screening (Screening) (September 2011–December 2012, and 3) Universal Screening + Intervention (Intervention)(July 2012-November 2013.
Setting
Eight EDs in the United States
Participants
Adults with a recent suicidal attempt or ideation were enrolled.
Intervention
Universal 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
The primary outcome was suicide attempts (non-fatal and fatal) over the 52-week follow-up. The proportion and total number of attempts were analyzed.
Results
1,376 participants (56% female, median age 36 years) were recruited. 288 participants (21%) made at least one suicide attempt. 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%). However, when compared to the TAU Phase, subjects 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 (IRR, 0.72, 95%CI 0.52–1.00, P=0.05), but no differences between the TAU and Screening phases (IRR, 1, 95%CI 0.71–1.41, P=0.99).
Conclusions
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.
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