An emergency department intervention for linking pediatric suicidal patients to follow-up mental health treatment.
OBJECTIVE
Suicide is the third leading cause of death among adolescents. Many suicidal youths treated in emergency departments do not receive follow-up treatment as advocated by the National Strategy for Suicide Prevention. Two strategies for improving rates of follow-up treatment were compared.


METHODS
In a randomized controlled trial, suicidal youths at two emergency departments (N=181; ages ten to 18) were individually assigned between April 2003 and August 2005 to one of two conditions: an enhanced mental health intervention involving a family-based cognitive-behavioral therapy session designed to increase motivation for follow-up treatment and safety, supplemented by care linkage telephone contacts after emergency department discharge, or usual emergency department care enhanced by provider education. Assessments were conducted at baseline and approximately two months after discharge from the emergency department or hospital. The primary outcome measure was rates of outpatient mental health treatment after discharge.


RESULTS
Intervention patients were significantly more likely than usual care patients to attend outpatient treatment (92% versus 76%; p=.004). The intervention group also had significantly higher rates of psychotherapy (76% versus 49%; p=.001), combined psychotherapy and medication (58% versus 37%; p=.003), and psychotherapy visits (mean 5.3 versus 3.1; p=.003). Neither the emergency department intervention nor community outpatient treatment (in exploratory analyses) was significantly associated with improved clinical or functioning outcomes.


CONCLUSIONS
Results support efficacy of the enhanced emergency department intervention for improving linkage to outpatient mental health treatment but underscore the need for improved community outpatient treatment to prevent suicide, suicide attempts, and poor clinical and functioning outcomes for suicidal youths treated in emergency departments.
Department of Psychiatry and Semel Institute, University of California, Los Angeles, Los Angeles, CA 90024-1759, USA. jasarnow@mednet.ucla.edu
Joan Rosenbaum
JR
Asarnow
Larry J
LJ
Baraff
Michele
M
Berk
Charles S
CS
Grob
Mona
M
Devich-Navarro
Robert
R
Suddath
John C
JC
Piacentini
Mary Jane
MJ
Rotheram-Borus
Daniel
D
Cohen
Lingqi
L
Tang
D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003156:Community Mental Health Services; D003866:Depressive Disorder / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005196:Family Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010351:Patient Discharge; D010865:Pilot Projects; D012044:Regression Analysis; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology; D016896:Treatment Outcome; D055815:Young Adult; D000092864:Suicide Prevention