Original study by Edwin Boudreaux, Carlos A. Camargo, Ivan Miller, & “the ED-SAFE investigators.”


As we continue to learn from home during this strange fall semester, The NAN Project brings to you a quick bit of suicide prevention science. 

The ED-SAFE study, published in 2018 by the Massachusetts Department of Mental Health, echoes some truths about suicide prevention that The NAN Project brings to high school classrooms: 1) the first step in suicide prevention is detecting risk; 2) persistence is the key to supporting a person at risk; and, 3) intervention led by the person at risk is most successful. 

ED-SAFE began in 2009 in response to a critical need for a suicide risk screener for patients in emergency departments. Suicide is the tenth leading cause of death in the United States, with one million people per year attempting suicide. Many individuals at risk for suicide are seen in emergency departments (“EDs”) for unrelated concerns. The ED-SAFE team argues that these are underutilized opportunities for suicide risk screening, and that to prevent suicide, ED-based screening and intervention for suicide risk must be developed. ED-SAFE aimed to test an intervention in which emergency departments screen for suicide risk using a standardized test, and initiate follow-up telephone contact with individuals who screened positive. 

1,376 adult ED patients were enrolled in this three-phase study, the third of which produced the most enlightening results. Phase three had testing sites implement a three-component intervention for patients who tested positive for suicide risk: first, a second screening to determine the level of risk; next, a personalized safety plan, with a guide to local outpatient mental health resources; and lastly, a series of phone calls to the patient by trained mental health advisors for a full year following the initial ED visit. 

It should be noted that treatment was not assigned to the patients (beyond check-in calls), nor were they pressured to comply with a treatment they had no part in developing – it was the patients’ decision to reach out for help using the provided resources. We know that it empowers the struggling person to lead their intervention, and that they are more likely to stick with a treatment they initiated. 

Results of ED-SAFE’s phase 3 showed that universal suicide risk screening within emergency departments almost doubled suicide risk detection. We know that identifying a person at risk for suicide is the first step in preventing suicide. The NAN Project teaches “signs of suicide” in our classroom presentations and professional development workshops, enabling young people and the adults in their lives to recognize these signs in their loved ones. ED-SAFE also found that the multifaceted, long-term suicide prevention invervention tested in phase 3 reduced suicidal behavior in patients by thirty percent. Persistence is key when supporting someone struggling with thoughts of suicide: this communicates to them that we care. The NAN Project highlights this in our QPR suicide prevention training, in which we encourage participants to ask a struggling person “the question” – namely, are they thinking of suicide – and to be sure that they follow up later on. 

The results of ED-SAFE demonstrate that a multi-component, persistent, patient-led suicide intervention is most successful. The research team predicts that their efforts will inform and accelerate the adoption of best practices for suicide prevention across diverse health settings, which would save countless patient lives.

The official Psychiatry Issue Brief on The ED-SAFE study can be found here.

As we work to become better supports to ourselves and the people in our lives, let us keep these findings in mind. And remember that there is help, and there is hope! 

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