[YSPNetwork] FYI: 2 articles: Emergency Depts. and Attempters

[Donna NOONAN]

YSPNetworkers,
SPRC's weekly Spark (http://www.sprc.org/news/index.asp) had 2 research
articles today on suicide attempters and hospital emergency
departments:
 

Trends in U.S. emergency department visits for suicide attempts,
1992-2001.
Larkin, G., Smith, R., Beautrais, A. (2008). Crisis, 9(2), 73-80.

This study used a national survey from the Centers for Disease Control
and Prevention that sampled patient visits to emergency departments
(EDs) across the United States, representing nearly one billion ED
visits over the decade. Over 50 million visits were for mental health
problems and approximately four million visits were for the treatment of
a suicide attempt. According to the report, the rate of ED visits for a
suicide attempt virtually doubled across the decade from .8 to 1.5 per
1000 persons; during the same time period the rate of suicide in the
U.S. declined 10 percent. The increases were concentrated in two age
groups: those under 15 years of age, and those ages 50-69. Suicide
attempt-related visits were most common (had the highest rate) among
non-Hispanic blacks. However, the sharp increases observed across the
decade were only significant for non-Hispanic whites. Suicide
attempt-related visits increased significantly in metropolitan areas,
but remained essentially unchanged in non-metropolitan areas. The report
provides additional analysis of mental health-related visits, regional
and gender variation, and patient disposition (e.g., inpatient admission
vs. discharge). The authors of the study concluded that *EDs are
increasingly important sites at which to identify, assess, treat,
manage, and support people who make suicide attempts.* By improving care
to this patient group, downstream risks for future attempts, fatal or
nonfatal, may be reduced along with the ED burden and costs of future
attempts. *Clinical and policy efforts should be directed toward
developing best practice models of medical care and psychosocial
assessment and treatment in emergency department settings,* added the
authors.
Link to Abstract ( http://www.ncbi.nlm.nih.gov/pubmed/18664232 )  I can
get you a copy of this article if you'd like.
And: 
Effectiveness of brief intervention and contact for suicide attempters:
a randomized controlled trial in five countries. (available online at
http://www.who.int/bulletin/volumes/86/9/07-046995.pdf)
Fleischman, A., Bertolote, J., Wasserman, D., DeLeo, D., Bolhari, J.,
Botega, N., et al. (2008). Bulletin of the World Health Organization,
86(9), 703-709.

This World Health Organization study was conducted in five countries,
all outside the United States. It was remarkable in that it showed that
a brief intervention*given as close as possible to the time of the
emergency department visit for a suicide attempt followed by contacts by
phone or face-to-face visit over eighteen months*substantially decreased
the rate of suicide during the follow-up period as compared to patients
receiving treatment as usual. However, we must recognize the significant
difficulties involved in conducting randomized controlled trials in low-
and middle-income countries, especially when follow-up is required over
many months. Still, this study appears to be of great importance when
considering the immense burden of the estimated one million suicide
deaths that occur worldwide each year. Its significance to suicide
prevention in the U.S. is much less certain, however. An important
aspect of this study*s design (which we did not point out in our
previous report) was that in most cases, the *treatment as usual*
provided to those who were randomized to the control group included no
psychosocial assessment, treatment or follow-up care whatsoever. In
other words, care in the emergency department was limited to treatment
of the physical injuries, followed by discharge. This treatment is very
different from what most patients would experience in emergency
departments in the U.S. Nonetheless, the magnitude of the protection
afforded
 these patients through a very brief psychoeducational
intervention and regular contact with a health care professional over
the months following the attempt is noteworthy. Brief emergency
department-based interventions and post-suicide attempt follow-up
warrant rigorous study in the United States.
Link to Abstract ( http://www.ncbi.nlm.nih.gov/pubmed/18797646 ) Link
to Full Text ( http://www.who.int/bulletin/volumes/86/9/07-046995.pdf )

Take care.
Donna
Donna G. Noonan, MPH, CHES
Youth Suicide Prevention Coordinator
Injury Prevention & Epidemiology Program
Oregon Public Health Division
800 NE Oregon, Ste 772
Portland, OR 97232
Phone: 971-673-1023 
Fax 971-673-0990
donna.noonan at state.or.us 
www.oregon.gov/dhs/ph/ipe/ysp/ 

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