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Ranking among the top 10 leading causes of death, suicide is a significant health concern in the US. Research has established that individuals who access Emergency Department EDs present deliberate self-harm symptoms and record the highest rates of suicide. Various literature gives extensive findings on the contributors to the high suicide-risk factors in EDs. Healthcare staff and patients who have visited EDs have a high suicidal behavior associated with a complex and multifactorial phenomenon. Findings from the statistical analysis and multiple pieces of literature will highlight the severity of the problem while evaluating various causes and recommendations. The paper attempts to acknowledge the causes of high suicide attempts resulting in the death of patients and staff in EDs and provide preventative solutions.
There is a national trend in suicides by patients related to ED visits in the US. A study by Canner et al. (2018) using the National Emergency Department Samples (NEDS) found that 3 567,084 suicide attempts related to ED visits were reported between 2006 and 2013. Youths aged 15-19 were the most affected age demographic, whereas females were the most affected by gender. The publication indicates the statistical trajectory of suicide attempts as a result of ED visits or hospitalization in the US compared to other regions. Findings from the study inform the research on the ferocity of ED-related self-harm among patients who visit EDs over the years. The research question will draw the causal factors and indicators of suicide among patients who have been to EDs.
However, older people who have visited EDs have higher somatic susceptibility due to underlying physical and mental illnesses. Costanza et al. (2020) describe why older people who have visited EDs are a high-risk factor for suicide, inferring from registry cohorts, case-control studies, suicide notes, coroners, and autopsy reports on the relationship between suicidal behavior and ideation and the elderly in EDs. Mental comorbidity is shared among the elderly and plays a significant role in suicide. Additionally, the high-cost burden of emergency admissions triggers depression and suicide ideation among elderly patients. Canner et al. (2018) and Costanza et al. (2020) provide statistical evidence of suicide prevalence among patients who have left EDs and the underlying causes. There are diverse causes of high suicide prevalence among the different age demographics after discharge from mental health ED visits.
Utilizing Virtual Collaborative Assessment and Management of Suicide System V-CAMS is a viable tool for facilitating best practice and care delivery using technology to mitigate suicide among patients and personnel in EDs (Dimeff et al., 2020). The article highlights that in-patient treatment contributes to overcrowding, low quality of care, patient distress and high cost of healthcare, causing suicide. Introducing CAMS to minimize ED patients visits, symptom distress, price, staff workload, and depression is practical in managing ED-related suicides (Dimeff et al., 2020). Patients who undertake behavioral therapy and seek screening and treatment for suicidal ideations are more likely to visit EDs. Inquiry of contemporary evidence-based solutions is imperative to the research to support recommendations for the problem.
However, a survey by DeVylder et al. (2019) underwrites that ED visits for screening for suicide ideation create the risk for subsequent suicide, dismissing it as an effective method of early detection and intervention for suicide. A retrospective cohort study of 15 003 youths in a pediatric ED in the US for suicidal thoughts indicates a positive association between suicide and subsequent suicidal behavior (DeVylder et al., 2019). The Joint Commission TJC recommends that all individuals treated for behavioral health conditions undergo screening for suicidal thoughts in all healthcare facilities using the Sentinels Event Alert. Moreover, the research highlights the hazard of limited predictive ability by screening tools by TJC and overreliance on clinical judgment on the risk of self-harm, rendering the screenings unreliable. The article is essential to acknowledge the research question of some policy and system challenges calibrating the high suicide rates among patients who have visited EDs.
Both studies by Dimeff et al. (2020) and DeVylder et al. (2019) deduce that screening for self-harm symptoms and visiting EDs contribute to ensuing self-harm ideation. Although Dimeff et al. (2020) endorse using CAMS to substitute physical visits to EDs as a method of mitigating suicidal ideas for patients receiving behavioral therapy, the study does not underscore the risks of collective testing and the psychological testing burden of testing positive. In contrast, DeVylder et al. (2019) evaluate the drawbacks of screening and notifying patients of potential suicidal thoughts, particularly those presenting psychiatric problems that expose them to suicidal ideation.
While the research by Dimeff et al. (2020) will provide a technical solution for replacing ED visits with V-CAMS to support the research question, the findings of DeVylder et al. (2019) will highlight policy factors that further the problem and limitations of suicide behavior screening. While V-CAMs can partially address the solutions to the research problem, the mandatory examination of suicidal thoughts needs scientific re-examination of their ensuing effects owing to the findings (DeVylder et al., 2019). Much as Canner et al. (2018) foreground that youth are the most vulnerable age demographics to suicide related to visiting EDs, Costanza et al. (2019) features that the elderly are at a high-risk factor due to comorbidity and extant health complications. Drawing from the literature, the research will propose technical and policy solutions to manage the prevalence of patients suicide following ED visits.
Research has indicated that not only patients who visit EDs are susceptible to suicide but also physicians. Stehman et al. (2019) found that Physicians in emergency medicine are at the highest risk of suicide among care providers, contributing to various psychological issues. The study finds burnout to be the leading cause of other psychological problems, including emotional exhaustion, depersonalization, and a diminished sense of self-accomplishment, leading to suicide. Intolerance to an error in EDs, long working hours, and student debt subject the emergency staff to high burnout and depersonalization scores, exposing health workers to suicidal thoughts. However, the study only pivoted on workers burnout as the sole cause of high suicide rates by ED physicians. Adjacent to the research question, comprehending the occupational satisfaction and motivation factors affecting physicians in EDs leading them to suicide is elemental to give insight into the roots of the problem.
Although burnout is a psychological syndrome, it is not the sole risk factor for suicidal ideation in ED staff. Delineating the factors for high suicide rates among workers in EDs will highlight the administrative and environmental aspects leading to high suicide rates. DeLucia et al. (2019) find that suicide rates among care providers are not only contributed by workplace stressors but also traumatic events by assessing the prevalence of post-traumatic stress disorder (PTSD) in the US. Psychological breakdowns experienced by physicians are due to excessive strain in their roles, mentally intrusive events, excessive sense of responsibility, and perfectionism. Health workers in emergency medicine deal with severely injured patients causing some traumatic events; hence, PTSD is a critical suicide impulse. Even though DeLucia et al. (2019) emphasize the substantial burden of PTSD on Emergency physicians, the study does not utilize modifiable risk factors such as the working environment.
While more research on suicidal ideation among physicians is still relevant, the research question is fraught with ethical, ethical, and mental well-being concerns. There is an emerging consensus that some aspects of healthcare workers work conditions and support are unacceptable. The evidence-informed review by Harvey et al. (2019) accentuates that unregulated physicians working environment, workload, support organizations and mental well-being have led to increasing reports of suicide. Harvey et al. (2019) provide a review of the comprehensive aspects of physicians workplace, ethical, and mental stability, ranging from training to organizational-level interventions. The literature will hint at the suggestions to the research question aimed at improving psychological well-being and ethical and occupational standards, hence mitigating suicide by physicians in EDs.
To conclude, the literature review indicates the harsh trend in ED-related suicides, yet there is still little research regarding practical intervention to curb the crisis. Reviewed empirical evidence suggests staff in ED are affected by multitudinous practice, ethical, and cognitive welfare issues yet to be resolved and bridle high suicidal ideation and attempts. Patients who visit EDs, depending on demographics, are susceptible to suicide ideation influenced by screening and underlying health conditions. Physicians in EDs face challenges of an unfavorable working environment, perfectionist expectations in emergency medicine, poor organizational support and mental care. Indeed, suicide by patients and staff in EDs is a critical healthcare challenge that needs to be resolved immediately.
References
Canner, J. K., Giuliano, K., Selvarajah, S., Hammond, E. R., & Schneider, E. B. (2018). Emergency department visits for attempted suicide and self-harm in the USA: 20062013. Epidemiology and psychiatric sciences, 27(1), 94-102. Web.
Costanza, A., Amerio, A., Radomska, M., Ambrosetti, J., Di Marco, S., Prelati, M., Aguglia, A., Serafini, G., Amore, M., Bondolfi G. & Pompili, M. (2020). Suicidality assessment of the elderly with physical illness in the emergency department. Frontiers in psychiatry, 11, 558974. Web.
DeLucia, J. A., Bitter, C., Fitzgerald, J., Greenberg, M., Dalwari, P., & Buchanan, P. (2019). Prevalence of post-traumatic stress disorder in emergency physicians in the United States. Western journal of emergency medicine, 20(5), 740. Web.
Dimeff, L. A., Jobes, D. A., Chalker, S. A., Piehl, B. M., Duvivier, L. L., Lok, B. C.,. & Koerner, K. (2020). A novel engagement of suicidality in the emergency department: Virtual Collaborative Assessment and Management of Suicidality. General hospital psychiatry, 63, 119-126.
Harvey, S. B., Epstein, R. M., Glozier, N., Petrie, K., Strudwick, J., Gayed, A., Dean, K. & Henderson, M. (2021). Mental illness and suicide among physicians. The Lancet, 398(10303), 920-930. Web.
Stehman, C. R., Testo, Z., Gershaw, R. S., & Kellogg, A. R. (2019). Burnout, drop out, suicide: physician loss in emergency medicine, part I. Western Journal of Emergency Medicine, 20(3), 485. Web.
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