Suicide risk among emergency care patients: Exploring incidental risk detection during routine care

Universal screening improves detection of suicide risk in emergency department (ED) patients presenting with a medical chief complaint, referred to as incidental risk. We sought to better understand characteristics of individuals who present with incidental suicide risk and evaluate their suicide-related outcomes after the ED visit.

The Emergency Department Safety Assessment and Follow-up Evaluation 2 (ED-SAFE 2) trial involved eight geographically diverse EDs. We randomly sampled data from two samples (cross-sectional, longitudinal) to compare patients with incidental risk to those with either negligible (i.e., screened negative for suicide risk) or congruent risk (i.e., behavioral health patients with suicide risk), as well as evaluate suicide-related outcomes in the 24 weeks after the ED visit. Chi-square tests, Student's t-tests, Fisher's exact tests, and one-way ANOVAs were used.

The relative percentage of incidental versus congruent risk was largely similar across sex, race, and ethnicity groups. Those with congruent or incidental risk were younger than those with negligible risk. Compared to congruent risk, incidental risk was driven more frequently by a past suicide attempt without recent ideation and was less likely to result in a behavioral health evaluation or intervention during the visit. Both congruent and incidental risk groups had substantial post-visit suicidal behavior, though rates were higher with congruent risk.

ED patients with suicide risk incidental to their chief complaint often have significant risk factors for suicide and exhibit elevated post-visit suicidal behavior but are less likely than those with congruent risk to receive a behavioral health evaluation or intervention during the visit.