ED-SAFE Investigators: Michael H. Allen, M.D. (University of Colorado School of Medicine); Edward Boyer, M.D., Ph.D. (University of Massachusetts); Jeffrey Caterino, M.D., M.P.H. (Ohio State University Medical Center); Robin Clark, Ph.D. (University of Massachusetts); Mardia Coleman (University of Massachusetts Medical School); Barry Feldman, Ph.D. (University of Massachusetts Medical School); Amy Goldstein, Ph.D. (National Institute of Mental Health); Talmage Holmes, Ph.D. (University of Arkansas for Medical Sciences Medical Center); Maura Kennedy, M.D. (Beth Israel Deaconess Medical Center); Frank LoVecchio, D.O. (Maricopa Medical Center); Sarah Arias, Ph.D. (Massachusetts General Hospital); Lisa Uebelacker, Ph.D. (Memorial Hospital of Rhode Island); Wesley Zeger, D.O. (University of Nebraska Medical Center)
Prevention and Treatment
KNOWLEDGE, ATTITUDES, AND PRACTICES OF EMERGENCY DEPARTMENT PROVIDERS IN THE CARE OF SUICIDAL PATIENTS
Article first published online: 20 FEB 2013
© 2013 Wiley Periodicals, Inc.
Depression and Anxiety
Volume 30, Issue 10, pages 1005–1012, October 2013
How to Cite
Betz, M. E., Sullivan, A. F., Manton, A. P., Espinola, J. A., Miller, I., Camargo, C. A., Boudreaux, E. D. and on behalf of the ED-SAFE Investigators (2013), KNOWLEDGE, ATTITUDES, AND PRACTICES OF EMERGENCY DEPARTMENT PROVIDERS IN THE CARE OF SUICIDAL PATIENTS. Depress. Anxiety, 30: 1005–1012. doi: 10.1002/da.22071
Contract grant sponsor: National Institute of Mental Health; Contract grant number: U01MH088278.
- Issue published online: 7 OCT 2013
- Article first published online: 20 FEB 2013
- Manuscript Accepted: 16 JAN 2013
- Manuscript Revised: 27 DEC 2012
- Manuscript Received: 23 OCT 2012
- National Institute of Mental Health. Grant Number: U01MH088278
- emergency medicine;
- healthcare provider
We sought to examine the knowledge, attitudes, and practices of emergency department (ED) providers concerning suicidal patient care and to identify characteristics associated with screening for suicidal ideation (SI).
Six hundred thirty-one providers at eight EDs completed a voluntary, anonymous survey (79% response rate).
The median participant age was 35 (interquartile range: 30–44) years and 57% of the participants were females. Half (48%) were nurses and half were attending (22%) or resident (30%) physicians. More expressed confidence in SI screening skills (81–91%) than in skills to assess risk severity (64–70%), counsel patients (46–56%), or create safety plans (23–40%), with some differences between providers. Few thought mental health provider staffing was almost always sufficient (6–20%) or that suicidal patient treatment was almost always a top ED priority (15-21%). More nurses (37%, 95% confidence interval [CI] 31–42%) than physicians (7%, 95% CI 4–10%) reported screening most or all patients for SI; this difference persisted after multivariable adjustment. In multivariable analysis, other factors associated with screening most or all patients for SI were self-confidence in skills, (odds ratio [OR] 1.60, 95% CI 1.17–2.18), feeling that suicidal patient care was a top ED priority (OR 1.73, 95% CI 1.11–2.69) and 5+ postgraduate years of clinical experience (OR 2.06, 95% CI 1.03–4.13).
ED providers reported confidence in suicide screening skills but gaps in further assessment, counseling, or referral skills. Efforts to promote better identification of suicidal patients should be accompanied by a commensurate effort to improve risk assessment and management skills, along with improved access to mental health specialists.