Interventions decrease post emergency room suicidal behavior

Providing a range of interventions for suicidal patients beyond the standard care in emergency rooms lowered the risk of repeat attempts by 30 percent.

That result came out of a large clinical trial led by Brown University and Butler Hospital psychologist Ivan Miller, Ph.D. The study, published in JAMA Psychiatry, involved 1,376 patients in eight hospital EDs who had a recent suicide attempt or ideation.

The trial had three phases. The first group consisted of 497 people who received “treatment as usual,” in the emergency room from August 2010 to December 2011.

The middle group was comprised of 377 individuals who underwent a universal suicide risk screening from September 2011 to December 2012.

The third set of 502 patients received universal screening plus intervention from July 2012 to November 2013.

Intervention included a secondary suicide risk screening by the ED physician, discharge suicide prevention resources from nurses and a personal safety plan to complete in case they harbored thoughts of suicide again.

In addition, for a year, patients received periodic follow up phone calls or check-ins from Butler Hospital providers who talked to them about personal values and goals, safety and future planning, problem solving and more.

Whenever possible, the follow up involved a designated loved one as well.

There was little difference between the proportion of people attempting suicide between the treatment as usual and screening groups, Miller explained, but a significant reduction in the number of attempts and people from the intervention phase.

The take away, Miller said, is that a “relatively low cost intervention, using a telephone follow up” is effective in helping patients curb their suicidal ideation.

“The fact that we were able to impact attempts with this population and with a relatively limited intervention is encouraging,” Miller said.

Researchers also looked at a broader suicide composite score that included attempts and deaths, but also interrupted or aborted attempts and acts of preparation for a suicide. Across all three groups, 46.3 reported one or more of these behaviors.

A total of five deaths occurred.

The good news, researchers found, was that the relative risk declined by 15 percent among people in the intervention compared to the standard care group.

The emergency departments are still using the intervention and there is an initiative underway designed to strengthen the safety plan component to make it more comprehensive, he said.

Other studies are looking at follow up procedures used with patients leaving psychiatric hospitals, Miller added.

To psychologists, the study results shine a spotlight on the importance of placing more of a focus on suicidal behavior and the telephone as an alternative method of contacting patients who may not otherwise seek help at their offices.

“The advantage of the telephone call is that we’re reaching out to them and not relying upon them to take the initiative for follow up or treatment,” Miller said. “There are patients who are reluctant to be in treatment or reach out for help in these circumstances.”

Miller is a professor of psychiatry and human behavior at Brown University and director of psychosocial research at Butler Hospital.

The research was funded by the National Institute of Mental Health.