Journal Article Annotations
2020, 1st Quarter
Kemuel Philbrick, MD, FACLP
March 30th, 2020
The Findings:
A concerted effort to develop and implement a suicide checklist tool designed to mitigate environmental risk factors and optimize bedside care of at-risk patients in a general hospital while also improving communication and hand-offs among clinical staff was received enthusiastically by nurses on nonpsychiatric units and was associated with a decrease in safety incidents in the year following its implementation.
Strengths and Weaknesses:
This tool illustrates one means of constructing and applying a standardized checklist to facilitate the systematic reduction of potential hazards in the environment and management of general hospital patients who are assessed to be at heightened risk for self-harm or suicide. Although not every detail of the checklist will translate directly to all other institutions, the full checklist is provided and can serve as a stepping-stone template for other hospitals who share an interest in providing nursing staff with a methodical approach to risk reduction.
Relevance:
Although suicides in the general hospital are uncommon (averaging about 85 annually over the last five years according to the Joint Commission), C/L services regularly encounter at-risk patients for whom psychiatric transfer may not be immediately medically feasible or logistically available. For those patients, interventions that improve their safety while awaiting further definitive psychiatric care are welcome.
Type of study:
Description of a suicide prevention checklist for the care of general hospital patients.
The Findings:
Although there had been a slight downward trend in suicide amongst men in the pre-recession period (2004-2008), this was followed by a rise in each quarter during the recession (2009-2011), and then a slight downward trend once again in the recession recovery period (2012-2016). The increased incidence of suicide during the recession was most prominent in men aged 45-54 and those who were unemployed. There were no clear suicide trends in terms of overall incidence related to the recession in women, either in those who had a history of mental health difficulties, or those in the general population. However, women who died by suicide during the recession were more likely to be unemployed and have a comorbid diagnosis of drug misuse/dependence.
Strengths and Weaknesses:
This was an ambitious attempt to appreciate recession-related trends and characteristics of patients who elected suicide before, during, and after a season of particular economic difficulty. The selected time periods do not reflect the evolution of economic phenomena and the adverse economic consequences of the recession were aggregate findings that would not necessarily apply to all individuals in equal fashion. As a study in the United Kingdom, some of the findings may be less applicable to countries with different social supports and health systems.
Relevance:
The economic consequences of the SARS-CoV-2 virus are many. Job restriction or loss, debt, medical expense, educational disruption, diminished personal agency and self-esteem, amongst a multitude of other individual hardships will likely threaten the capacity of many individuals to cope effectively. As consult psychiatrists encountering diverse patients in the months ahead, we will serve them better by remaining vigilant and sensitive to the gang of adversities they may experience in the wake of a looming recession.
Type of study:
Retrospective observational review.