title: Pediatric suicide-related presentations: a systematic review of mental health care in the emergency department.
abstract: OBJECTIVE
  We evaluate the effectiveness of interventions for pediatric patients with suicide-related emergency department (ED) visits.
  
  
  METHODS
  We searched of MEDLINE, EMBASE, the Cochrane Library, other electronic databases, references, and key journals/conference proceedings. We included experimental or quasiexperimental studies that evaluated psychosocial interventions for pediatric suicide-related ED visits. Inclusion screening, study selection, and methodological quality were assessed by 2 independent reviewers. One reviewer extracted the data and a second checked for completeness and accuracy. Consensus was reached by conference; disagreements were adjudicated by a third reviewer. We calculated odds ratios, relative risks (RRs), or mean differences for each study's primary outcome, with 95% confidence intervals (CIs). Meta-analysis was deferred because of clinical heterogeneity in intervention, patient population, and outcome.
  
  
  RESULTS
  We included 7 randomized controlled trials and 3 quasiexperimental studies, grouping and reviewing them according to intervention delivery: ED-based delivery (n=1), postdischarge delivery (n=6), and ED transition interventions (n=3). An ED-based discharge planning intervention increased the number of attended post-ED treatment sessions (mean difference=2.6 sessions; 95% CI 0.05 to 5.15 sessions). Of the 6 studies of postdischarge delivery interventions, 1 found increased adherence with service referral in patients who received community nurse home visits compared with simple placement referral at discharge (RR=1.28; 95% CI 1.06 to 1.56). The 3 ED transition intervention studies reported (1) reduced risk of subsequent suicide after brief ED intervention and postdischarge contact (RR=0.10; 95% CI 0.03 to 0.41); (2) reduced suicide-related hospitalizations when ED visits were followed up with interim, psychiatric care (RR=0.41; 95% CI 0.28 to 0.60); and (3) increased likelihood of treatment completion when psychiatric evaluation in the ED was followed by attendance of outpatient sessions with a parent (odds ratio=2.78; 95% CI 1.20 to 6.67).
  
  
  CONCLUSIONS
  Transition interventions appear most promising for reducing suicide-related outcomes and improving post-ED treatment adherence. Use of similar interventions and outcome measures in future studies would enhance the ability to derive strong recommendations from the clinical evidence in this area.
authors.affiliation: Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. mandi.newton@ualberta.ca
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Newton
authors.forename: Michele P
authors.initials: MP
authors.lastname: Hamm
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bethell
authors.forename: Anne E
authors.initials: AE
authors.lastname: Rhodes
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Bryan
authors.forename: Lisa
authors.initials: L
authors.lastname: Tjosvold
authors.forename: Samina
authors.initials: S
authors.lastname: Ali
authors.forename: Erin
authors.initials: E
authors.lastname: Logue
authors.forename: Ian G
authors.initials: IG
authors.lastname: Manion
mesh_terms: D000293:Adolescent; D002648:Child; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008605:Mental Health Services / Q000592:standards / Q000706:statistics & numerical data; D016017:Odds Ratio; D010351:Patient Discharge / Q000592:standards / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data; D012306:Risk; D013406:Suicide, Attempted / Q000517:prevention & control / Q000706:statistics & numerical data
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