Severe Pain Can Trigger Suicide in Hospital ERs

WEDNESDAY Dec. 15, 2010 -- A group that accredits many U.S. hospitals has urged hospital and emergency-room caregivers to watch for attempted suicides in patients with no history of psychiatric problems.

The new alert, issued by the Joint Commission, stresses that it's not just psychiatric patients who kill themselves, citing as an example someone recently diagnosed with cancer who goes to an ER because the cancer-related pain has become unbearable.

"A patient who attempts suicide in the emergency room or a hospital's medical or surgical unit often has a different set of presenting complaints or a different diagnosis than a patient hospitalized in a psychiatric unit," said Dr. Robert Wise, a psychiatrist and medical adviser to the commission's division of healthcare quality evaluation.

The alert suggests strategies to help hospitals and ERs reduce the risk for suicide among such patients.

Of the 827 suicides reported to the commission since 1995, almost 25 percent occurred in non-psychiatric settings, such as emergency rooms, cancer and intensive-care units and long-term care hospitals, the commission noted. The methods most often used were hanging, suffocation, intentional drug overdose and strangulation.

Because the suicides are reported voluntarily, there's no way to know how common the act is, Wise said. But a hospital in which a suicide occurs examines the circumstances to determine potential causes, "and that's probably more important than the actual prevalence, as it can help to prevent future occurrences," he said.

People with illnesses that cause chronic pain, such as cancer, or that cause a slow mental deterioration, such as dementia, may begin to have thoughts of suicide, he said.

"A patient diagnosed with cancer who is in intense, intractable pain may feel worn out and hopeless, even though they may not talk about the associated emotional issues of their disease," Wise said, adding that caregivers may not think to ask about it because that's not their initial focus.

"Emergency room and hospital staffs tend to see medical illness -- the high fever, chest pains that suggest serious medical problems," he said. "They may be less likely to think about how a cancer patient in unremitting pain feels when they are told the increase of pain is caused by the spread of the disease."

Elana Premack Sandler, a prevention specialist with the U.S. Suicide Prevention Resource Center, said that the commission's alert highlights the fact that not every person who dies by suicide has a psychiatric history. It gets health-care providers in hospital settings "to think outside the box about their roles -- to be equipped to know the warning signs of suicide and respond appropriately," she said.

Those warnings include irritability, agitation, complaints of unrelenting pain, refusing visitors or medications and requesting early discharge, the commission noted. Dementia, chronic pain or illness, end-stage cancer, acute signs of depression and drug or alcohol intoxication may also heighten suicide risk.

"These are signs that anyone -- like friends, family or co-workers -- can be aware of," Sandler said. And anyone who notices such signs, she said, should reach out to hospital staff or other mental-health professionals who could help.

Teaching hospital and ER staff members about suicide risk factors and warning signs of an imminent attempt is the first step, the alert said. Other strategies include:

  • Doing suicide screenings in the ER.
  • Screening all patients for depression when they're admitted to a hospital.
  • Checking anyone deemed to be at risk for items they could use to harm themselves.
  • Encouraging staff to call a mental health professional to evaluate patients believed to be at risk.

Suicide is the 10th leading cause of death in the United States, with 34,598 reported suicides in 2007, according to the U.S. National Institute of Mental Health.

More information

The U.S. National Institute of Mental Health has more on suicide prevention.

Posted: December 2010


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