New intervention may help identify and improve care for adolescents at risk for suicide

Investigators at Nationwide Children's Hospital and Cincinnati Children's Hospital Medical Center are hoping to better identify adolescents at risk for suicide and improve how these at-risk children receive follow up mental health treatment. Thanks to a $1.2 million grant from the Centers for Disease Control and Prevention, the two hospitals will conduct a three-year study to test a new intervention targeting adolescents during emergency department visits.

Many adolescents are identified as suicidal when they present to the emergency department following a suicide attempt. Thirty percent of suicidal adolescents return to the emergency department with another crisis within six months of discharge from the emergency department. Other patients who are at risk for suicide go unrecognized when presenting to the emergency department for a non-psychiatric concern.

No evidence-based standards exist for how to appropriately screen and intervene for patients who are treated in the emergency department and who show an elevated risk for suicide, says Jackie Grupp-Phelan, M.D., M.P.H., Director of Research in the Division of Emergency Medicine at Cincinnati Children's.

The goal is to maximize the initiation of mental health treatment and aftercare among adolescents screening positive for previously unrecognized suicide risk, says Jeff Bridge, PhD, principal investigator in the Center for Innovation in Pediatric Practice of The Research Institute at Nationwide Children's Hospital and a faculty member at The Ohio State University College of Medicine.

The team of researchers will recruit 160 adolescents (80 per site) seeking treatment in the emergency department for non-psychiatric concerns, but who are identified via systematic screening as being at risk for suicide. Participants will be randomly assigned to receive either the new intervention or enhanced usual care. Enhanced usual care consists of a brief consultation and a mental health referral. The new intervention, termed Suicidal Teens Accessing Treatment after an ED Visit (STAT-ED), targets family engagement, problem solving, assistance with referral and limited case management during the transition from the emergency department to outpatient care.

STAT-ED was previously studied among a small group of patients, families and clinicians, was well-accepted by participants and proved to be more effective than enhanced usual care. The study between Nationwide Children's and Cincinnati Children's will provide a larger, more diverse sample from two geographically separate, urban pediatric emergency departments serving broad populations.

The team will also examine whether STAT-ED is more effective than enhanced usual care in reducing suicidal ideation and depression symptoms after emergency department discharge. The rationale is that by using the pediatric emergency department to identify and treat unrecognized suicide risk, adolescents will be less likely to overuse emergency department services in the future, have a better quality of life and ultimately have a reduced risk of morbidity and mortality, says Dr. Grupp-Phelan.

Dr. Bridge says if STAT-ED proves successful, it will provide a brief and sustainable intervention that can be implemented across diverse pediatric emergency department settings.