Effect of a Motivational Interviewing–Based Intervention on Initiation of Mental Health Treatment and Mental Health After an Emergency Department Visit Among Suicidal Adolescents

Abstract

IMPORTANCE Emergency department (ED) visits present opportunities to identify and refer suicidal youth for outpatient mental health care, although this practice is not routine.OBJECTIVE To examine whether a motivational interviewing-based intervention increases linkage of adolescents to outpatient mental health services and reduces depression symptoms and suicidal ideation in adolescents seeking emergency care for non-mental health-related concerns who screen positive for suicide risk. DESIGN, SETTING, AND PARTICIPANTSIn this randomized clinical trial, adolescents aged 12 to 17 years who screened positive on the Ask Suicide Screening Questions (ASQ) during a nonpsychiatric ED visit at 2 academic pediatric EDs in Ohio were recruited from INTERVENTIONS The Suicidal Teens Accessing Treatment After an Emergency Department Visit (STAT-ED) intervention included motivational interviewing to target family engagement, problem solving, referral assistance, and limited case management. The enhanced usual care (EUC) intervention consisted of brief mental health care consultation and referral. MAIN OUTCOMES AND MEASURES Primary outcomes were mental health treatment initiation and attendance within 2 months of ED discharge and suicidal ideation (assessed by the Suicidal Ideation Questionnaire JR) and depression symptoms (assessed by the Center for Epidemiologic Studies-Depression scale) at 2 and 6 months. Exploratory outcomes included treatment initiation and attendance and suicide attempts at 6 months. RESULTS A total of 168 participants were randomized and 159 included in the intention-to-treatanalyses (mean [SD] age, 15.0 [1.5] years; 126 [79.2%] female; and 80 [50.3%] white). Seventy-nine participants were randomized to receive the STAT-ED intervention and 80 to receive EUC. At 2 months, youth in the STAT-ED group had similar rates of mental health treatment initiation compared with youth in the EUC group as assessed by parent report (29 [50.9%] vs 22 [34.9%]; adjusted odds ratio [OR], 2.08; 95% CI, 0.97-4.45) and administrative data from mental health care agencies (19 [29.7%] vs 11 [19.3%]; adjusted OR, 1.77; 95% CI, 0.76-4.15). At 2 months, youth in the STAT-ED group and the EUC group had similar rates of treatment attendance (1 appointment: 6 [9.7%] vs 2 [3.6%]; adjusted OR, 2.97; 95% CI, 0.56-15.73; Ն2 appointments: 10 [16.1%] vs 7 [12.7%]; adjusted OR, 1.43;95% CI, 0.50-4.11). There were no significant group × time differences in suicidal ideation (F = 0.28; P = .72) and depression symptoms (F = 0.49; P = .60) during the 6-month follow-up period. In (continued)

The effect of motivational interviewing-based training on the rate of using mental health services and intensity of suicidal ideation in individuals with suicide attempt admitted to the emergency department

“…While there was no statistically significant difference in using mental health services at 2-month follow-up, the MI group began receiving most psychiatric treatments and regularly attending therapeutic sessions at 6-month follow-up. [ 32 ] The reason the intervention did not produce the desired outcome after 2 months, unlike what happened in the present study, could be that – as the parents of these adolescents stated – many participants were unable to access mental health services because of logistical barriers, scheduling problems, and long waiting lists. Conversely, in the present study, arrangements were made for participants willing to use mental health services to refer to a psychiatrist or counselor.…”

Screening for Suicide Risk in Hospital Admissions: What are the Next Questions?

“…Suppose that this youth does not need hospital admission but does need community care. Unfortunately, a substantial proportion of community referrals do not result in completed treatment [9]. Finally, assuming that the hospital has screened a youth, detected the risk of a suicide attempt, and arranged to deliver a mental health treatment, and the youth attends the appointment, then that treatment has to work to prevent a suicide attempt.…”

Psychological and neurobiological aspects of suicide in adolescents: Current outlooks

“…At 3 month follow-up however, it appears the intervention group had two more patients with suicide attempts compared to the control group. Four more patients in the intervention group were hospitalized compared to controls ( Grupp-Phelan et al., 2019 ).…”