Emergency departments have a unique place in health care. Every day, they treat people in crisis – not just after accidents, assaults, overdoses, but also when diseases take a bad turn, whether it’s asthma gone out of control, or a hidden cardiac problem that leads to a heart attack.
To get fast answers about what’s wrong, what caused the crisis, and how best to tackle it, ED teams often run a slew of tests, and if they suspect someone has a substance abuse problem, for example, they’ll screen the patient for that as well.
Now Ivan Miller, director of psychosocial research at Butler Hospital, is examining whether EDs should routinely test for suicide risks as well – not just when patients are visibly at risk, but also when they have cancer or some other serious condition that could lead to suicidal thoughts.
Funded by a $12 million federal grant, the five-year, three-phase study will cover eight EDs, including Memorial Hospital of Rhode Island. The goal is to assess how EDs now screen for suicide risks, develop a new screening tool, and then refine it for maximum effectiveness.
Miller answered questions about the project.
PBN: What drew you to this subject?
MILLER: The Psychosocial Research Program at Butler Hospital conducts research on psychosocial interventions for psychiatric disorders, primarily mood disorders (depression and bipolar disorder). For the past 20 years, one of our major areas of interest has been developing and testing interventions for severely depressed and suicidal individuals. Most of this previous work has been done at Butler. Recently, we have developed an intervention designed to reduce risk for suicide in patients recently discharged from a psychiatric hospital. The hospital ED study is an expansion of our work in the psychiatric hospital to a different setting.
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PBN: Why focus on EDs in particular?
MILLER: EDs are a critical setting to implement screening and intervention for suicide because for many people, the ED is the place where they have initial (or any) contact with the health care system. In recent years, EDs have seen increasing numbers of mental health problems and suicide. However, most EDs do not have systematic procedures in place for screening or treating potentially suicidal patients. In a majority of EDs, only patients who have apparent mental health problems or have actually injured themselves are screened. While these procedures detect the most obvious cases, they are likely to miss other patients who may be a serious risk for suicide but do not have clear psychiatric symptoms or do not spontaneously volunteer their thoughts regarding suicide.
PBN: How common is it for people who’ve just suffered a heart attack or are newly diagnosed with a serious disease to become suicidal?
MILLER: Individuals with serious medical conditions are at increased risk for suicide. In the majority of cases, this risk is not associated with an initial diagnosis or acute condition, but more with how long the disease may last and the individual’s sense of hopelessness regarding the future. But obviously, there is a wide variety of response to having a medical illness. Some people cope very well despite terrible illnesses. For others, especially those with other risk factors for suicide, less severe medical problems may lead to suicidal thinking.
PBN: Tell us more about the study itself.
MILLER: The study has two major aims: to evaluate whether systematic screening for suicide in EDs improves the detection of suicide, and to evaluate whether an intervention initiated in the ED and continued by telephone after ED discharge reduces subsequent risk for suicidal behavior. The study is coordinated at the University of Massachusetts Medical School, Massachusetts General Hospital and Butler Hospital. The study will take place at eight EDs across the country. Memorial Hospital of Rhode Island is one of the research sites; no other EDs in Rhode Island are involved. Mass. General is a coordinating site, but will not recruit subjects for the study.
PBN: Are you hoping to create a new screening and treatment protocol that can be adopted by EDs across the country? How long a timeline are we looking at?
MILLER: This is a five-year study, which currently has four more years to complete. At the end of the study, we hope to have developed and tested screening and intervention procedures that can be used in a variety of EDs to reduce suicidal behavior.
