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16 Emergency department patients with suicide risk: impact of alcohol intoxication
  1. Chantel Urban1,
  2. Marian E Betz2,
  3. Sarah A Arias3,
  4. Daniel L Segal4,
  5. Ivan Miller3,
  6. Carlos A Camargo5,
  7. Edwin D Boudreaux6
  1. 1US Colorado School of Public Health
  2. 2US Department of Emergency Medicine, University of Colorado School of Medicine
  3. 3US Department of Psychiatry and Human Behaviour, Brown University, Butler Hospital
  4. 4US University of Colorado at Colorado Springs
  5. 5US Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School
  6. 6US Departments of Emergency Medicine, Psychiatry, and Quantitative Health Science, University of Massachusetts Medical School


Statement of purpose To identify care differences between those with and without alcohol intoxication among emergency department (ED) patients who screened positive for suicide risk.

Methods This was a retrospective, observational study of electronic medical records at an urban ED with universal suicide risk screening. Eligible patients had screened positive (‘active suicide ideation’ or ‘suicide attempt within past 6 months’) between January 2014 and December 2015. We reviewed a random sample of charts from three a priori age groups (18–34 years, n=300; 35–59 years, n=300; and 60+years, n=200) for demographic, medical, and visit characteristics. The primary outcomes were evaluation by a mental health professional, provision of resources, and ED disposition.

Results Suicidal individuals who were intoxicated (blood alcohol level >0 or other intoxication documentation) were more often males aged 35–59 years. Intoxicated, suicidal individuals were less likely than those who were not intoxicated to see a mental health professional during the ED visit (72% vs 84%, p<0.0001), or be admitted/transferred to a psychiatric or substance abuse facility (21% vs 30%, p-value<0.0001). Intoxicated individuals were more likely to be discharged home (68% vs 59%, p-value<0.0001) and receive referral resources (63% to 56%, p<0.0001).

Conclusion There were discrepancies in ED care between intoxicated and non-intoxicated patients. This may relate to patients who express suicidality while intoxicated and recant once sober, leading to a less thorough evaluation. It may also reflect difficulty engaging patients in mental health care while intoxicated.

Significance Alcohol intoxication is a risk factor for suicide, yet it can complicate risk assessment by impairing patients’ judgement and thinking. While guidelines recommend suicidal ED patients receive a comprehensive risk assessment, this may not always occur. ED providers may need additional education or guidelines to enhance best practice for these cases.

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