Recent Interventions for Acute Suicidality Delivered in the Emergency Department: A Scoping Review

Area of Science:

• Emergency Medicine
• Psychiatry
• Clinical Pharmacology

Background:

• Suicidality presents a significant challenge in the US, with emergency departments (EDs) serving as critical points of care for acutely suicidal patients.
• A lack of established interventions for emergency physicians managing acute suicidality necessitates a review of recent advancements.
• This scoping review aims to identify and evaluate recent interventions for EDs to manage and treat acute suicidality.

Purpose of the Study:

• To systematically review the literature for recently described interventions applicable in the ED setting for acute suicidality.
• To identify interventions that can reduce symptoms and stabilize acutely suicidal patients within the ED environment.

Main Methods:

• A comprehensive literature search was conducted in PubMed, SCOPUS, and CINAHL for studies published between 2013 and 2023.
• Nine original research articles met the inclusion criteria after assessing 16 full-text articles.
• Included studies were evaluated for intervention characteristics, ED environment fit, and efficacy.

Main Results:

• Four studies examined the efficacy of ketamine, an anesthetic/analgesic agent.
• Three studies evaluated brief psychosocial interventions, with two incorporating follow-up care (postcard contact, case management).
• Two studies tested motivational interviewing-based interventions; ketamine and Crisis Response Planning (CRP) showed the most promise for ED appropriateness and efficacy.

Conclusions:

• The review identified one drug (ketamine) and four psychological/behavioral interventions for acute suicidality in the ED.
• Current evidence is insufficient to confirm the efficacy and suitability of these interventions for routine ED delivery.
• Further research is essential to determine the feasibility and efficacy of these interventions in the ED setting.