Study Objective-We evaluated the effectiveness of interventions for pediatric patients with suicide-related emergency department (ED) visits.Methods-We searched of MEDLINE, EMBASE, the Cochrane Library, other electronic databases, references, and key journals/conference proceedings. We included experimental or quasi-experimental studies that evaluated psychosocial interventions for pediatric suicide-related ED visits. Inclusion screening, study selection, and methodological quality were assessed by two
CIHR Author ManuscriptCIHR Author Manuscript CIHR Author Manuscript independent reviewers. One reviewer extracted the data and a second checked for completeness and accuracy. Consensus was reached by conference; disagreements were adjudicated by a third reviewer. We calculated odds ratios (OR), relative risks (RR), or mean differences (MD) for each study's primary outcome with 95% confidence intervals (CI). Meta-analysis was deferred due to clinical heterogeneity in intervention, patient population, and outcome.Results-We included 7 RCTs and 3 quasi-experimental studies grouping and reviewing them according to intervention delivery: ED-based delivery (n=1), post-discharge delivery (n=6), and ED transition interventions (n=3). An ED-based discharge planning intervention increased the number of attended post-ED treatment sessions (MD=2.6; 95%CI:0.05,5.15). Of the 6 studies of post-discharge delivery interventions, one found increased adherence with service referral in patients who received community nurse home visits compared to simple placement referral at discharge (RR=1.28; 95%CI:1.06,1.56). The 3 ED transition intervention studies reported: (1) reduced risk of subsequent suicide following brief ED intervention and post-discharge contact (RR=0.10; 95%CI:0.03,0.41), (2) reduced suicide-related hospitalizations when ED visits were followed up with interim, psychiatric care (RR=0.41; 95%CI:0.28,0.60), and (3) increased likelihood of treatment completion when psychiatric evaluation in the ED was followed by attendance of outpatient sessions with a parent (OR=2.78; 95%CI:1.20,6.67).Conclusion-Transition interventions appear most promising for reducing suicide-related outcomes and improving post-ED treatment adherence. Use of similar interventions and outcome measures in future studies would enhance the ability to derive strong recommendations from the clinical evidence in this area.
