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Comment & Response |

Addressing Suicide Risk in Emergency Department Patients

Mark Olfson, MD, MPH1; Steven C. Marcus, PhD2; Jeffrey A. Bridge, PhD3
[+] Author Affiliations
1Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
2Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
3Research Institute at Nationwide Children's Hospital, Center for Innovation in Pediatric Practice, Columbus, Ohio
JAMA. 2014;312(3):298. doi:10.1001/jama.2014.7155.
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In Reply We agree with Dr Hoyer that there is ample room for improvement in the emergency care of suicidal patients and that priority should be given to research on emergency assessment and management. We further agree that screening for suicide risk, which seldom occurs in routine emergency care,1 can alert emergency staff to individuals who may be at high risk.

In a large, diagnostically mixed research sample, for example, patients who reported a history of suicidal ideation with intent and behavior on the Columbia-Suicide Severity Rating Scale were approximately 9 times more likely than those without such histories to report suicidal behavior during the following 2 months.2 Beyond screening for risk factors, clinical evaluations should focus on detecting warning signs that can serve as targets for clinical intervention such as feeling trapped, escalating drug or alcohol use, recent social withdrawal, or dramatic mood changes.3 Training emergency medicine residents in the evaluation of suicidal patients offers the potential to build their skills in identifying high-risk patients and referring them for appropriate interventions.


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July 16, 2014
David Hoyer, MD
1Department of Emergency Medicine, University of Texas Health Science Center, Houston
JAMA. 2014;312(3):297-298. doi:10.1001/jama.2014.7149.
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