Surprising rate of hidden suicidality among people attending A & E Departments
Apr 6, 2005 - 6:31:38 PM

There was a surprising rate of hidden suicidality among those attending a hospital Accident and Emergency department for non-psychiatric reasons, a new study has found.

The study published in the April 2005 issue of the British Journal of Psychiatry found that more that 11% of the patients studied had thoughts that they would 'be better off dead', and more than 8% reported that they had thought about killing themselves.

A review of the medical records, revealed that 25 of the 31 patients actively planning suicide were undetected during their visit to & A&E.

This American study was designed to assess the feasibility of using a computerised test to measure mood, anxiety and substance-related symptoms. Patients reporting suicidality were divided into three categories:

* passive ideation - frequent thoughts of death and thinking that they would 'be better off dead'
* active ideation - specific thoughts about self-harm
* ideation with intent/planning - agreement with the statement 'I am planning to kill myself'.

A cross-sectional sample of patients over 17 years-old in the waiting room of the emergency department of Parkland Memorial Hospital in Dallas, Texas, were assessed during randomised time blocks over a 45-day period.

Only patients whose chief complaint was unrelated to mental health were recruited, and all patients gave permission to the researchers to access their medical records.

Sufficient data for analysis were available for 1590 patients who completed the computerised questionnaire. Nearly 100% of all those reporting passive and active ideation, as well as suicidal intent, acknowledged underlying psychological symptoms indicating mood disorder and/or anxiety and/or substance-related disorder.

Depression was most common, and was associated with severity of ideation (68% of those with passive ideation v. 74% of those planning suicide), as were panic attacks (43% v. 55%). Roughly a third of each group also endorsed substance misuse (36% - 38%).

Four of the 31 patients expressing suicidal intent at the start of the study attempted suicide within 45 days. All survived.

The authors of the study comment that the prevalence of current suicidal ideation with intent to attempt suicide in this sample was 2%, which is consistent with rates found in other settings. Yet even seriously suicidal people in this study were not identified during routine care.

Compared with the general population, those att&g A&E departments may be at significant risk of suicide. Given the hidden and insidious nature of this problem, future work will need to consider strategies for unmasking this largely undetected threat to public health.

Any prospective screening for psychotherapy &e A&E department should make provision for discovery and treatment of suicidal individuals.

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