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Psychiatr Serv. 2016 Feb;67(2):206-13. doi: 10.1176/ Epub 2015 Dec 1.

Factors Associated With Suicide Outcomes 12 Months After Screening Positive for Suicide Risk in the Emergency Department.

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Dr. Arias and Dr. Miller are with the Department of Psychiatry and Human Behavior, Brown University, Butler Hospital, Providence, Rhode Island (e-mail: ). Dr. Camargo and Ms. Sullivan are with the Department of Emergency Medicine, Massachusetts General Hospital, Boston. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Allen is with the University of Colorado Depression Center and Rocky Mountain Crisis Partners, Aurora. Dr. Manton is with the Center for Behavior Health Services, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Department of Emergency Medicine and Department of Psychiatry, University of Massachusetts Medical School, Worcester.



The main objective was to identify which patient characteristics have the strongest association with suicide outcomes in the 12 months after an index emergency department (ED) visit.


Data were analyzed from the first two phases of the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE). The ED-SAFE study, a quasi-experimental, interrupted time-series design, involved participation from eight general medical EDs across the United States. Participants included adults presenting to the ED with active suicidal ideation or an attempt in the past week. Data collection included baseline interview; six- and 12-month chart reviews; and six-, 12-, 24-, 36-, and 52-week telephone follow-up assessments. Regression analyses were conducted.


Among 874 participants, the median age was 37 years (interquartile range 27-47), with 56% of the sample being female (N=488), 74% white (N=649), and 13% Hispanic (N=113). At baseline, 577 (66%) participants had suicidal ideation only, whereas 297 (34%) had a suicide attempt in the past week. Data sufficient to determine outcomes were available for 782 (90%). In the 12 months after the index ED visit, 195 (25%) had documentation of at least one suicide attempt or suicide. High school education or less, an ED visit in the preceding six months, prior nonsuicidal self-injury, current alcohol misuse, and suicidal intent or plan were predictive of future suicidal behavior.


Continuing to build an understanding of the factors associated with future suicidal behaviors for this population will help guide design and implementation of improved suicide screening and interventions in the ED and better allocation of scarce resources.

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