Suicide screening scales may not adequately predict disposition of suicidal patients from the emergency department

Mullinax, Samuel; Chalmers, Christen E.; Brennan, Jesse J.; Vilke, Gary M.; Nordstrom, Kimberly; Wilson, Michael P.

doi:10.1016/j.ajem.2018.01.087

Cited by 20 publications

(17 citation statements)

References 21 publications

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“…Forty studies were further excluded because of identical or overlapping patient samples. A total of 115 studies reporting 167 samples were included in the meta‐analysis (SM 2, Table of Included Studies, and SM 3 Data used in meta‐analysis). The samples included 46 samples of females, 46 samples of males and 75 samples of both sexes.…”

Section: Resultsmentioning

confidence: 99%

Meta‐analysis of suicide rates among people discharged from non‐psychiatric settings after presentation with suicidal thoughts or behaviours

Wang

Swaraj

Chung

et al. 2019

Acta Psychiatr Scand

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analysis of suicide rates among people discharged from non-psychiatric settings after presentation with suicidal thoughts or behaviours.Objective: To quantify the suicide rate among people discharged from nonpsychiatric settings after presentations with suicidal thoughts or behaviours. Method: Meta-analysis of studies reporting suicide deaths among people with suicidal thoughts or behaviours after discharge from emergency departments or the medical or surgical wards of general hospitals. Results: A total of 115 studies reported 167 cohorts and 3747 suicide deaths among 248 005 patients during 1 263 727 person-years. The pooled suicide rate postdischarge was 483 suicide deaths per 100 000 person-years (95% confidence interval (CI) 445-520, prediction interval (PI) 200-770) with high between-sample heterogeneity (I 2 = 92). The suicide rate was highest in the first year postdischarge (851 per 100 000 person-years) but remained elevated in the long term. Suicide rates were elevated among samples of men (716 per 100 000 person-years) and older people (799 per 100 000 person-years) but were lower in samples of younger people (107 per 100 000 person-years) and among studies published between 2010 and 2018 (329 per 100 000 person-years). Conclusions: People with suicidal thoughts or behaviours who are discharged from non-psychiatric settings have highly elevated rates of suicide despite a clinically meaningful decline in these suicide rates in recent decades. Summations• The pooled suicide rate among patients with suicidal thoughts or behaviours following discharge from a non-psychiatric setting was 483 per 100 000 person-years (95% CI 445-520).• Suicide rates were lower among samples of younger people (<25 years of age) and among more recently published studies, but were higher in the first year after discharge, among older people (>55 years of age), and men.• All patients presenting to emergency departments and general hospitals with suicidal thoughts or behaviours warrant a careful assessment and individualized treatment planning. Considerations• High between-study heterogeneity limits the extent to which the results can be regarded as generalizable.• The meta-analysis could not examine a range of clinical factors that might contribute to variation in suicide rates.• Few studies from low-and middle-income countries could be included.

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Section: Resultsmentioning

confidence: 99%

Meta‐analysis of suicide rates among people discharged from non‐psychiatric settings after presentation with suicidal thoughts or behaviours

Wang

Swaraj

Chung

et al. 2019

Acta Psychiatr Scand

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“…30,31 It is suggested that risk-assessment tools and scales should not be used to predict future suicide or repeated self-harm, and they should not be the sole criterion to decide on treatment options. 32,33 However, the scales can be used as a part of a holistic clinical assessment. 34 The current evidence base is not robust enough to suggest any particular scale for routine clinical use to predict suicide.…”

Section: Discussionmentioning

confidence: 99%

Suicide by psychiatric patients: Nature of risk, risk categorisation and preventability

Kar

Prasad

2019

Med Sci Law

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This study considers risk factors associated with suicide by psychiatric patients, the perceived risk at last contact and risk categorisation and reflects upon the potential for prevention. Information regarding 63 consecutive suicides known to mental health services in Wolverhampton, UK, over a 15-year period was collected as part of an audit using a semi-structured questionnaire covering sociodemographic and clinical risk factors, along with information about preventability. A complex mixture of historical, enduring and current risk factors was observed. In addition to common risk factors, a considerable proportion had histories of multiple co-morbid psychiatric (52.5%) and physical diagnoses (27.6%) and psychiatric admission (70.5%). Common suicide methods included hanging (36.5%) and poisoning (36.5%). Most suicides occurred in the post-discharge months up to around two years (75.8%). Although a range of psychopathologies and suicidal cognitions were observed at the last clinical contact, the immediate suicide risk was considered low (46.2%) or not present (38.5%) in the majority of cases. Clinicians suggested various factors that could have made suicides less likely. Clinical assessment can identify risk factors, but categorisation may not be indicative of the outcome. A focus on modifiable factors, with support for psychosocial and clinical issues, may assist with prevention.

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“…Given that ACEP recommends the discharge of mild suicide risk patients, 24 The use of adjunct measures of suicide risk may also increase confidence and competency in these areas. However, given the number of available adjunct measures of suicide risk with low predictive validity and a limited number of measures suitable for use in the fast-paced ED setting, 24,[49][50][51][52] further research is needed, particularly in the use of machine learning to improve suicide risk prediction. 42,53 Future work in the ED setting should focus on incorporating valid and reliable predictive algorithms as an aid to existing clinical decisionmaking practices, while also aligning suicide risk decisions with appropriate and evidence-based clinical interventions to reduce patient suicide risk.…”

Section: Limitationsmentioning

confidence: 99%

An investigation of clinical decisionmaking: identifying important factors in treatment planning for suicidal patients in the emergency department

et al. 2020

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Objective We sought to evaluate the influence of several well‐documented, readily available risk factors that may influence a psychiatric consultant's decision to admit an emergency department (ED) patient reporting suicidal ideation for psychiatric hospitalization. Methods We conducted a retrospective study of adult patients presenting to six affiliated EDs within Pennsylvania from January 2015 to June 2017. We identified 533 patients reporting current active suicidal ideation and receiving a complete psychiatric consultation. Socio‐demographic characteristics, psychiatric presentation and history, and disposition were collected. Decision tree analysis was conducted with disposition as the outcome. Results Four of 27 variables emerged as most influential to decisionmaking, including psychiatric consultant determination of current suicide risk, patient age, current depressive disorder diagnosis, and patient history of physical violence. Likelihood of admission versus discharge ranged from 97% to 58%, depending on the variables considered. Post hoc analysis indicated that current suicide plan, access to means, lack of social support, and suicide attempt history were significantly associated with psychiatric consultant determination of moderate‐to‐high suicide risk, with small‐to‐medium effect sizes emerging. Conclusions Only a handful of variables drive disposition decisions for ED patients reporting current active suicidal ideation, with both high and low fidelity decisions made. Patient suicide risk, determined by considering empirically supported risk factors for suicide attempt and death, contributes the greatest influence on a psychiatric consultant's decision to admit. In line with American College of Emergency Physicians (ACEP) recommendations, this study accentuates the importance of using clinical judgment and adjunct measures to determine patient disposition within this population.

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Suicide screening scales may not adequately predict disposition of suicidal patients from the emergency department

Cited by 20 publications

References 21 publications

Meta‐analysis of suicide rates among people discharged from non‐psychiatric settings after presentation with suicidal thoughts or behaviours

Meta‐analysis of suicide rates among people discharged from non‐psychiatric settings after presentation with suicidal thoughts or behaviours

Suicide by psychiatric patients: Nature of risk, risk categorisation and preventability

An investigation of clinical decisionmaking: identifying important factors in treatment planning for suicidal patients in the emergency department

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