Recorded presentation

Gregory Luke Larkin, MD MS MSPH, Surgery, Emergency Medicine, Clinical Sciences, University of Texas Southwestern, 5323 Harry Hines Boulevard, CS 2.122, Dallas, TX 75390-8579, 1( 214) 648-2904, gregory.larkin@utsouthwestern.edu and Cynthia A Claassen, PhD, Psychiatry, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390.

OBJECTIVES: Suicide surveillance systems have primarily focused on overt suicidal behavior while larger issues of covert suicidal ideation and intent have remained largely unmeasured and undocumented. Since many suicide completers vist EDs for reasons other than suicide before their death, we sought to establish the prevalence of occult suicidality in patients seeking treatment for routine, non-psychiatric problems in the ED. METHOD: A prospective cohort of 1600 ED patients were recruited during random time blocks using an anonymous, computerized mental health assessment measuring the tripartite construct of suicidality: passive ideation, active ideation, and serious intent. RESULTS: Passive ideation was endorsed in 11.6% of all patients while 8.4% acknowledged imminent plans to kill themselves. African Americans were most likely and Hispanics least likely to endorse passive and active suidical ideation [OR=1.5(1.1,2.1);0.50(0.34,0.73), respectively.] Patients reporting both intent and a plan were demographically similar to all other ED patients with similar reasons for visit. Fully 97% of 184 ideators screened positive for one or more mood, anxiety or substance-related disorders, and 30% of 31 seriously suicidal subjects endorsed problems in all three of these Axis I domains. Of 31 actively suicidal patients, 24 remained undetected receiving neither psychiatric diagnoses nor referral; none died but four returned within 90 days of discharge having made serious attempts. CONCLUSION: Occult suicidality is common in ambulatory ED patients presenting for non-psychiatric problems; suicidal intent may be unmasked with simple questioning procedures during routine ED evaluation.

Learning Objectives:

• Learners will be able to describe the prevalence of occult suicidality in emergency department patients
• Learners will be able to list specific comorbid illnesses most commonly associated with suicidality.
• Learners will be able to list specific risk and demographic factors associated with occult suicidality in ED patients.

Keywords: Suicide, Emergency Department/Room

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation