Pediatric suicide-related presentations: a systematic review of mental health care in the emergency department.
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.
Newton
Amanda S
AS
Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. mandi.newton@ualberta.ca
Hamm
Michele P
MP
Bethell
Jennifer
J
Rhodes
Anne E
AE
Bryan
Craig J
CJ
Tjosvold
Lisa
L
Ali
Samina
S
Logue
Erin
E
Manion
Ian G
IG
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
MMWR Surveill Summ. 2008 Jun 6;57(4):1-131
18528314
Control Clin Trials. 1996 Feb;17(1):1-12
8721797
J Clin Child Adolesc Psychol. 2002 Mar;31(1):41-7
11845649
Ann Emerg Med. 2004 Apr;43(4):452-60
15039687
Behav Sci Law. 2004;22(5):651-65
15378593
Suicide Life Threat Behav. 2001 Summer;31(2):169-80
11459249
Br J Psychiatry. 1990 Feb;156:236-42
2180527
J Psychiatr Ment Health Nurs. 2008 Aug;15(6):512-22
18638213
Psychol Med. 1995 Sep;25(5):963-70
8588015
Health Rep. 2009 Jun;20(2):35-42
19728584
Suicide Life Threat Behav. 1977 Spring;7(1):17-20
206990
J Am Acad Child Adolesc Psychiatry. 2002 Apr;41(4):435-42
11931600
Postgrad Med. 2000 Nov;108(6):155-6
11098267
Br J Psychiatry. 2003 Jun;182:537-42
12777346
Suicide Life Threat Behav. 1994 Winter;24(4):382-94
7740595
Int Rev Psychiatry. 2008 Apr;20(2):177-82
18386209
Inj Prev. 1997 Jun;3(2):115-9
9213157
Suicide Life Threat Behav. 2007 Feb;37(1):50-7
17397279
J Epidemiol Community Health. 1998 Jun;52(6):377-84
9764259
N Y State J Med. 1992 Mar;92(3):97-104
1557208
Am J Emerg Med. 1997 Jul;15(4):357-60
9217524
J Am Acad Child Adolesc Psychiatry. 1999 Mar;38(3):250-5
10087685
J Consult Clin Psychol. 2000 Dec;68(6):1081-93
11142542
Psychiatr Serv. 2004 Jul;55(7):792-7
15232019
J Adolesc Health Care. 1986 Mar;7(2):88-95
3957753
J Am Acad Child Adolesc Psychiatry. 2005 Feb;44(2):113-20
15689724
Behav Res Ther. 1997 Nov;35(11):1039-46
9431735
Bull World Health Organ. 2008 Sep;86(9):703-9
18797646
J Am Acad Child Adolesc Psychiatry. 2003 Apr;42(4):386-405
12649626
Acad Emerg Med. 2006 Apr;13(4):435-42
16531601
JAMA. 1995 Feb 1;273(5):408-12
7823387
J Am Acad Child Adolesc Psychiatry. 1999 Jun;38(6):660-71
10361783
Pediatrics. 2007 Sep;120(3):669-76
17766542
J Clin Psychiatry. 2007 Oct;68(10):1574-83
17960975
Curr Opin Pediatr. 2009 Oct;21(5):628-34
19644371
Suicide Life Threat Behav. 2007 Jun;37(3):264-77
17579539
J Adolesc Health. 2002 May;30(5):312-25
11996780
Suicide Life Threat Behav. 1998 Summer;28(2):174-86
9674077
Acad Emerg Med. 2007 Sep;14(9):810-8
17726127
Suicide Life Threat Behav. 2009 Aug;39(4):396-407
19792981
J Abnorm Psychol. 2005 May;114(2):291-303
15869359
J Pers Disord. 2004 Feb;18(1):102-16
15061347
J Am Acad Child Adolesc Psychiatry. 2004 Jan;43(1):80-7
14691363
Crisis. 2008;29(2):73-80
18664232
Suicide Life Threat Behav. 2007 Jun;37(3):248-63
17579538
J Clin Psychol. 2006 Feb;62(2):185-200
16342288
J Am Acad Child Adolesc Psychiatry. 2001 Jul;40(7):837-46
11437023
J Am Acad Child Adolesc Psychiatry. 2008 Aug;47(8):958-66
18596552
Eur J Emerg Med. 2003 Dec;10(4):283-7
14676505
J Med Libr Assoc. 2006 Apr;94(2):130-6
16636704
Can Psychiatr Assoc J. 1975 Feb;20(1):29-34
164270
Aust N Z J Psychiatry. 2005 Mar;39(3):121-8
15701059
J Clin Psychol. 2006 Feb;62(2):243-51
16342293
Curr Opin Pediatr. 2007 Aug;19(4):398-404
17630602
J Am Acad Child Adolesc Psychiatry. 1998 Sep;37(9):915-23
9735611
Psychiatr Serv. 2002 Dec;53(12):1574-9
12461218
Br J Psychiatry. 2002 Sep;181:193-9
12204922
J Am Acad Child Adolesc Psychiatry. 1996 May;35(5):654-63
8935213
Psychiatr Serv. 2007 Apr;58(4):561-5
17412862