Occult Suicidality and Psychiatric Disease Among Emergency Department Patients with Low-acuity Chief Complaints

Abstract

IntroductionPatients presenting to emergency departments (ED) are often screened for suicidality, even when their chief complaint does not involve mental health concerns. Patient receptiveness to ED-based mental health screening and intervention is unknown, particularly among patients with low-acuity chief complaints, who often prioritize rapid evaluation and discharge.MethodsThis cross-sectional study included adults with low-acuity chief complaints presenting to an urban, academic ED in the Northeastern United States during daytime and evening hours, from 2015 to 2016. Participants completed validated mental health screening instruments, including the Suicide Behaviors Questionnaire-Revised and the Patient Health Questionnaire-4. Participants were also asked to rate the importance of addressing mental health concerns during their ED visit.ResultsWe approached 1,688 patients, and 816 (48.4%) consented to participate in the study. Of these, 27% screened positive for anxiety and 25% screened positive for depression. Even among patients with no prior depression history, 17% were at high risk of depression. Eleven percent of participants were at high risk for suicidal behavior, including 5% of those with no reported history of depression or bipolar disorder. Thirty-five percent of patients at risk for suicide and 53% of those at high risk of depression thought it was important or very important to address these issues during the ED visit.ConclusionSymptoms of mental health disorders were common among this group of ED patients presenting with low-acuity chief complaints. Patients often desired to address these mental health concerns as part of their ED visit.

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“…9 Three American studies highlighted an increased prevalence of anxiety disorders among frequent visitors of the emergency department. [29][30][31] Fear and uncertainty have been identified as important motives of patients with chronic conditions to use emergency care. 32 In contrast, a systematic review found no significant effect of anxiety disorders on the use of urgent care in the eight identified studies.…”

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“…Health systems are struggling with the burden of suicide-related presentations, which now represent 1.5 million emergency department (ED) visits each year [ 3 ]. A significant proportion of those who died by suicide have visited an ED in the year before their death [ 4 ], and about one-eighth of general ED patients had endorsed suicidality when asked [ 5 , 6 ].…”

A Systematic Review of the Literature for Suicide Prevention Interventions Initiated in Emergency Departments in the United States

“…The Joint Commission recommended that all accredited hospitals and their EDs should implement universal screening of all patients for potential suicide risk, regardless whether they exhibit typical risk factors. Even for ED patients with low-acuity and non-suicidal chief complaints, up to 11% still indicated suicidal ideation when surveyed by mental health screening (McBride et al, 2018). All States have some form of commitment laws which allows providers to detain patients who are in imminent danger of serious harm.…”