Feb. 19, 2010 | Feb. 19, 2010 | Hoping to improve detection of suicide risk among patients in hospital emergency departments, the UAMS Department of Emergency Medicine is among eight sites participating in a National Institutes of Health study.

The Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) trial seeks to create a standardized approach for assessing and treating suicidal behavior.

“This is a public health problem but there have been relatively few controlled trials to evaluate interventions to reduce suicidal behavior,” said Talmage Holmes, Ph.D., M.P.H., an associate professor and research director in the Department of Emergency Medicine of the UAMS College of Medicine. “Plus, this is the good example of translational research – where we want to be able to quickly translate research findings into practices instituted in emergency departments across the country.”

The grant from the National Institute of Mental Health is the first received by the UAMS Department of Emergency Medicine. Holmes said emergency medicine is a young discipline, noting the UAMS department was only established in the 1980s and there is no National Institute of Emergency Medicine to promote research in the field.

“The success of this grant will depend on the participating sites, so we feel very privileged to be a part of this project,” Holmes said.

Holmes said emergency departments are well suited for this type of study. In 2006, there were more than 500,000 emergency department visits nationally that were related to self harm and the rates of active suicidal thoughts among emergency department patients has been estimated to range from 3 percent to more than 8 percent.

The project, beginning in June 2010, is expected to enroll nearly 1,420 participants over five years.

The eight participating sites were selected to represent both broad geographic regions of the United States and patient demographics. The sites are UMass Memorial in Worcester, Mass.; Memorial of Rhode Island in Pawtucket, R.I.; University of Colorado in Denver; Beth Israel Deaconess in Boston; Maricopa Integrated Health in Phoenix; Ohio State in Columbus, Ohio; UAMS and the University of Nebraska in Omaha, Neb.

The study will be coordinated by the Emergency Medicine Network (EMNet), based at Massachusetts General Hospital. The team of researchers will be led by Edwin D. Boudreaux, Ph.D., of the University of Massachusetts; Carlos A. Camargo Jr., M.D., Dr.P.H., of Massachusetts General Hospital and Harvard Medical School; and Ivan Miller, Ph.D., of Butler Hospital in Providence, RI.

The study will be conducted in three phases. Researchers will first examine current treatment of emergency department patients with psychiatric risk factors such as depression, suicidal thinking or behavior, or substance abuse. Next, a universal screening process will be tested in all patients regardless of whether or not they show typical suicidal risk factors. The two treatments will be compared for how well each detects suicidal patients.

Finally, a more intensive intervention will be implemented that includes screening, brief counseling, possibly an evaluation by a mental health provider, referral to outpatient care and other components. Patients will then receive follow-up phone counseling. The intensive intervention will be compared to current treatment practices and to universal screening.