Emergency room physicians see the impact of patients who attempt suicide. Too often these patients don't receive the ongoing care they need. The physicians in emergency medicine and psychiatry at the University of Colorado School of Medicine are working to better develop a standardized approach to caring for such patients by participating in a recently approved study supported by a five-year National Institutes of Mental Health cooperative agreement.

University of Colorado Hospital physicians will work to identify ways to improve the detection and prevention of suicide among patients who arrive at the hospital's emergency departments. The University of Colorado, through collaboration between the departments of emergency medicine and psychiatry and the University Colorado Hospital emergency department, is one of eight sites across the country involved in this research trial.

"Despite the public health significance of suicidal behavior, there have been relatively few controlled trials which evaluate interventions to reduce suicidal behavior," said Emmy Betz, M.D., M.P.H., department of emergency medicine and principal investigator for the hospital site. The emergency department setting "is well-suited for this type of research."

The Emergency Department Safety Assessment and Follow-up Evaluation Trial, known as ED-SAFE, was awarded to the University of Massachusetts's Medical School and is expected to enroll nearly 1,420 participants over five years. The objectives of this study:

• Develop and test a standardized approach to screening emergency department patients for suicide risk
• Refine and test an emergency department-initiated intervention to reduce suicidal behavior and associated morbidity and mortality among people who self-identify or screen positive for suicidal ideation
• Conduct a cost analysis to compare costs and benefits associated with emergency department suicide screening and intervention.

Michael H. Allen, M.D., of the University of Colorado Depression Center is co-investigator at the national level overseeing the work at all eight sites. He is the former president of the American Association for Emergency Psychiatry.

"In 2006, there were more than 500,000 (emergency department) visits related to intentional self-harm and the rate of patients with suicidal thoughts among (emergency department) patients at UCH is 5 percent," Allen said.

He said it has been difficult to engage potentially suicidal patients in treatment and that the treatment to be tested here is a carefully constructed series of telephone contacts including the patient's family. Results from this study should help doctors find ways to get more patients the treatment they need to improve their mental health.