An emergency department intervention for linking pediatric suicidal patients to follow-up mental health treatment

Abstract

Objective: Suicide is the third leading cause of death among adolescents. Many suicidal youths treated in emergency departments do not receive follow-up treatment as advocated by the National Strategy for Suicide Prevention. Two strategies for improving rates of follow-up treatment were compared.

Methods: In a randomized controlled trial, suicidal youths at two emergency departments (N=181; ages ten to 18) were individually assigned between April 2003 and August 2005 to one of two conditions: an enhanced mental health intervention involving a family-based cognitive-behavioral therapy session designed to increase motivation for follow-up treatment and safety, supplemented by care linkage telephone contacts after emergency department discharge, or usual emergency department care enhanced by provider education. Assessments were conducted at baseline and approximately two months after discharge from the emergency department or hospital. The primary outcome measure was rates of outpatient mental health treatment after discharge.

Results: Intervention patients were significantly more likely than usual care patients to attend outpatient treatment (92% versus 76%; p=.004). The intervention group also had significantly higher rates of psychotherapy (76% versus 49%; p=.001), combined psychotherapy and medication (58% versus 37%; p=.003), and psychotherapy visits (mean 5.3 versus 3.1; p=.003). Neither the emergency department intervention nor community outpatient treatment (in exploratory analyses) was significantly associated with improved clinical or functioning outcomes.

Conclusions: Results support efficacy of the enhanced emergency department intervention for improving linkage to outpatient mental health treatment but underscore the need for improved community outpatient treatment to prevent suicide, suicide attempts, and poor clinical and functioning outcomes for suicidal youths treated in emergency departments.

Trial registration: ClinicalTrials.gov NCT00558805.

Conflict of interest statement

Disclosures of conflicts of interest (relative to the last 12 months): Dr Asarnow receives research grants from the National Institute of Mental Health; and received honoraria from the California Institute of Mental Health, Hathaways-Sycamores, Casa Pacifica, and the Melissa Institute. Dr Baraff has no financial disclosures or conflicts of interests to report. Dr Berk has no financial disclosures or conflicts of interest to report. Dr Grob has no financial disclosures or conflicts of interest to report. Dr Devich-Navarro has no financial disclosures or conflicts of interests to report. Dr Suddath has no financial disclosures or conflicts of interest to report. Dr Piacentini has received grant support from the National Institute of Mental Health, the Tourette Syndrome Association, the Obsessive Compulsive Foundation, and the Eisner Family Foundation. He has also received royalties from Oxford University Press for OCD and tic treatment manuals and from Guilford Press and the American Psychological Association Press for books on child mental health. In addition, he has received a consultancy fee from Bayer Schering Pharma and speaking honoraria for CME presentations from the Tourette Syndrome Association. Dr Rotheram-Borus has no financial disclosures or conflicts of interest to report. Mr Cohen has no financial disclosures or conflicts of interest to report. Dr Tang has no financial disclosures or conflicts of interest to report.