Mental Health
Characteristics and post-visit suicide outcomes of emergency department patients who screen positive for suicide incidental to their chief complaint Edwin Boudreaux* Alan Ardelean Edwin Boudreaux Joseph Ciminelli Sarah Arias Carlos Camargo Ivan Miller
Background and Objective: Universal screening improves suicide risk detection in individuals presenting to the emergency department (ED) who are not presenting with a psychiatric chief complaint, what we refer to as incidental risk. We sought to better understand characteristics of individuals who present with incidental risk and to evaluate their suicide-related outcomes after the ED visit.
Methods: Two samples from the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study were used. Combined, the samples allowed for comparison of baseline characteristics and suicide-related outcomes for participants with incidental risk compared to those with negligible risk (any kind of chief complaint and negative suicide risk) and congruent risk (psychiatric chief complaint and positive suicide risk). We completed univariable and multivariable regression analyses and compared the proportions of participants with a suicide composite outcome over twelve months after the ED visit.
Results: Participants with incidental risk were generally more similar to those with congruent risk than negligible risk across demographics and clinical characteristics. In multivariable analyses, we identified older age, female sex, white race, and non-Hispanic/Latino ethnicity to be positively associated with having incidental risk, in addition to diabetes (aOR=1.97, 95% CI: 1.11-3.49) and chronic pain (aOR=2.05, 95% CI: 1.17-3.57). Those with incidental risk also exhibited similar post-visit suicide-related outcomes compared to those with congruent risk, yet they were far less likely to receive clinical assessments and interventions during the ED visit, such as an evaluation by a mental health professional (91.8% vs. 46.5%), [X2 (1, N =1,362) = 203.78, p <.001].
Conclusion: EDs may need to consider redesigning their clinical approach to address suicide risk among those who present with medical complaints but screen positive for suicide risk.