Depressed and Suicidal Patients in the Emergency Department: An Evidence-Based Approach

Points and Pearls Excerpt

• There is good evidence that a large percentage of all ED patients will screen positive for depression/suicidality. Screening for suicidality in the ED can be a critical intervention to get patients the help they need before a crisis.
• Major depressive disorder (MDD) is a big risk factor for suicidal ideation, but not all those who die by suicide are “depressed.”
• Risk factors for MDD include female gender, young or old age, being divorced or widowed, black or Hispanic ethnicity, having poor social support, and substance abuse.
• The strongest predictor for suicide-related outcomes is history of prior suicidal ideation or suicide attempt.

Most Important References

• Owens PL, Mutter R, Stocks C. Mental health and substance abuse-related emergency department visits among adults, 2007: statistical brief #92. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006. (US government report)
• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. Washington DC: American Psychiatric Association; 2013. (Reference book)
• Grant BF, Stinson FS, Dawson DA, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004;61(8):807-816. (Survey data; 49,093 patients)
• Centers for Disease Control and Prevention. Current depression among adults---United States, 2006 and 2008. MMWR Morb Mortal Wkly Rep. 2010;59(38):1229-1235. (Government survey data analysis; 235,067 subjects)
• Murrough J, Soleimani L, DeWilde K, et al. Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial. Psychol Med. 2015;45(16):3571-3580. (Randomized controlled trial; 24 participants)
• Griffiths JJ, Zarate CA, Rasimas J. Existing and novel biological therapeutics in suicide prevention. Am J Prev Med. 2014;47(3):S195-S203. (Review article)