title: Screening for suicidality in the emergency department: when must researchers act to protect subjects' interests?
abstract: The emergency department (ED) is a key site in preventing suicide. Yet there has been very little research on ED screening and interventions targeting the suicidal patient. Conducting research on interventions for preventing suicidal behavior in the ED population may evoke the dilemma of how to fulfill ethical obligations to protect research subjects when doing so can impair the validity of the study. In this paper we present a case study of a research protocol on the utility of routine screening with a brief intervention for suicidal ideation that raised issues regarding researchers' obligation to disclose information about subjects' suicidality to ED staff. After exploring the imperfect relationship between suicidal ideation and completed suicide (i.e., many people with ideation never attempt or commit suicide), we present an analysis of the causal relationship between these phenomena. This leads us to suggest that it should not be mandatory for researchers to disclose to ED staff when a subject reveals suicide ideation in a screening questionnaire-although other preventive measures may be called for. In general, the extent of the duty placed on researchers to intervene on behalf of their subjects should be proportional to the likelihood and magnitude of risk presented to subjects by the underlying condition, and should be balanced against the importance of the research question.
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. atg2119@columbia.edu
authors.forename: Azgad
authors.initials: A
authors.lastname: Gold
authors.forename: Paul S
authors.initials: PS
authors.lastname: Appelbaum
authors.forename: Barbara
authors.initials: B
authors.lastname: Stanley
mesh_terms: D003219:Confidentiality; D004636:Emergency Service, Hospital; D032984:Ethics, Research; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D028681:Moral Obligations; D012108:Research Personnel / Q000941:ethics; D035842:Research Subjects; D035844:Researcher-Subject Relations / Q000941:ethics; D011795:Surveys and Questionnaires; D000092864:Suicide Prevention