Knowledge, Attitudes, and Practices of Emergency Department Providers in the Care of Suicidal Patients

UMMS Affiliation

Department of Emergency Medicine; Department of Psychiatry; Center for Health Policy and Research

Publication Date


Document Type



Suicide; Suicidal Ideation; Suicide, Attempted; Emergency Service, Hospital; Emergency Medical Services; Mental Health Services


Emergency Medicine | Health Services Administration | Health Services Research | Mental and Social Health | Psychiatry | Psychiatry and Psychology


BACKGROUND: We sought to examine the knowledge, attitudes, and practices of emergency department (ED) providers concerning suicidal patient care and to identify characteristics associated with screening for suicidal ideation (SI).

METHODS: Six hundred thirty-one providers at eight EDs completed a voluntary, anonymous survey (79% response rate).

RESULTS: The median participant age was 35 (interquartile range: 30-44) years and 57% of the participants were females. Half (48%) were nurses and half were attending (22%) or resident (30%) physicians. More expressed confidence in SI screening skills (81-91%) than in skills to assess risk severity (64-70%), counsel patients (46-56%), or create safety plans (23-40%), with some differences between providers. Few thought mental health provider staffing was almost always sufficient (6-20%) or that suicidal patient treatment was almost always a top ED priority (15-21%). More nurses (37%, 95% confidence interval [CI] 31-42%) than physicians (7%, 95% CI 4-10%) reported screening most or all patients for SI; this difference persisted after multivariable adjustment. In multivariable analysis, other factors associated with screening most or all patients for SI were self-confidence in skills, (odds ratio [OR] 1.60, 95% CI 1.17-2.18), feeling that suicidal patient care was a top ED priority (OR 1.73, 95% CI 1.11-2.69) and 5+ postgraduate years of clinical experience (OR 2.06, 95% CI 1.03-4.13).

CONCLUSIONS: ED providers reported confidence in suicide screening skills but gaps in further assessment, counseling, or referral skills. Efforts to promote better identification of suicidal patients should be accompanied by a commensurate effort to improve risk assessment and management skills, along with improved access to mental health specialists.

DOI of Published Version



Depress Anxiety. 2013 Feb 20. doi: 10.1002/da.22071. Link to article on publisher's site

Journal/Book/Conference Title

Depression and anxiety


The ED-SAFE Investigators include Edward W. Boyer, Robin E. Clark, Mardia A. Coleman, and Barry N. Feldman of the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID