eMedicine Specialties > Emergency Medicine > Psychosocial
Depression and Suicide: Follow-up
Updated: Jun 23, 2008
Follow-up
Further Inpatient Care
- When depression is diagnosed, particularly when suicidality is present or reasonably suspected, the primary care provider, often in consultation with a mental health professional, should design an interim disposition plan appropriate to the diagnosis and degree of risk that is assessed.
- This may require legal certification that the patient is in need of emergency evaluation and protective observation, emergency or short-course medication, contracting for safety with the patient, and/or releasing the patient in the protective custody of the family or law enforcement agency.
- While evaluating and securing an appropriate disposition for the patient, all staff members must take measures to ensure the safety and preserve the dignity of the patient.
Transfer
- Transfer is indicated when there is a need for protective custody or intensive intervention that is not available at the present institution.
Complications
- Suicide
- Failure to improve
- Drug reaction
Prognosis
- The ED can sometimes be the last opportunity for intervention in the downward spiral of depression, which leads to death for a significant number of those affected. Although the clinician may never see the results of protective intervention, statistics suggest that the presentation of a depressed and suicidal patient to a health care setting is an opportunity to really make a difference and possibly to save a life. Few diseases are as lethal yet so reversible as depression. Lives can be and are saved every day as the result of the timely efforts and empathic interventions of skilled and compassionate health care professionals who are knowledgeable, empathic, and motivated to deal effectively with depression.
Patient Education
- Patients must be told clearly and convincingly that depression is an eminently treatable illness.
- Carefully inform patients about the critical importance of taking any medications that are prescribed, as well as likely adverse effects and their management.
- Stress the need for short-term follow-up and continuing treatment.
- Recommend reading for patients. A good source of information about depression is the Depression and Affective Disorders Association as well as the National Alliance for the Mentally Ill.
- For excellent patient education resources, visit eMedicine's Depression Center and Antidepressants Center. Also, see eMedicine's patient education articles Depression, Suicidal Thoughts, Understanding Antidepressant Medications, and SSRIs and Depression.
Miscellaneous
Medicolegal Pitfalls
- Failure to recognize or appropriately hospitalize a suicidal patient
- Failure to document historical details demonstrating lack of suicidality
- Failure to follow transfer protocols in accordance with the Emergency Medicine Treatment and Active Labor Act (EMTALA) (Note that under current EMTALA interpretations, even a discharge is considered a transfer.)
- Failure to prescribe suicide precautions for a possibly suicidal patient who is discharged to an institutional setting (such as correctional facilities) rather than a psychiatric setting.
- Failure to warn others of any threat made concerning them by a patient who is not to be admitted to protective custody.
- Failure to provide a source of follow-up care or to advise on indications to return to the ED.
- Failure to warn patient and significant others about potential signs of deterioration and suicidality and what to do about them.
More on Depression and Suicide |
| Overview: Depression and Suicide |
| Differential Diagnoses & Workup: Depression and Suicide |
| Treatment & Medication: Depression and Suicide |
 Follow-up: Depression and Suicide |
| References |
| « Previous Page |
References
Angst J, Angst F, Stassen HH. Suicide risk in patients with major depressive disorder. J Clin Psychiatry. 1999;60 Suppl 2:57-62; discussion 75-6, 113-6. [Medline].
Apter A, Horesh N, Gothelf D, et al. Relationship between self-disclosure and serious suicidal behavior. Compr Psychiatry. Jan-Feb 2001;42(1):70-5. [Medline].
Gliatto MF, Rai AK. Evaluation and treatment of patients with suicidal ideation. Am Fam Physician. Mar 15 1999;59(6):1500-6. [Medline].
Harwitz D, Ravizza L. Suicide and depression. Emerg Med Clin North Am. May 2000;18(2):263-71, ix. [Medline].
Mann JJ, Apter A, Bertolote J, et al. Suicide prevention strategies: a systematic review. JAMA. Oct 26 2005;294(16):2064-74. [Medline].
Oquendo MA, Malone KM, Mann JJ. Suicide: risk factors and prevention in refractory major depression. Depress Anxiety. 1997;5(4):202-11. [Medline].
Osvath P, Voros V, Fekete S. Life events and psychopathology in a group of suicide attempters. Psychopathology. Jan-Feb 2004;37(1):36-40. [Medline].
Rives W. Emergency department assessment of suicidal patients. Psychiatr Clin North Am. Dec 1999;22(4):779-87, viii. [Medline].
SK Goldsmith, TC Pellmar, AM Kleinman. Reducing Suicide: A National Imperative. Institute of Medicine Monograph. National Academies Press 2002;[Full Text].
Verona E, Sachs-Ericsson N, Joiner TE. Suicide attempts associated with externalizing psychopathology in an epidemiological sample. Am J Psychiatry. Mar 2004;161(3):444-51. [Medline].
Further Reading
Keywords
depressive illness, mood disorder, suicidal, suicidality, suicide ideation, suicide attempt, suicide attempts, self-destructive acts, self-murder, suicide gesture, major depressive disorder, MDD, unipolar depression, unipolar affective disorder, serotonin, norepinephrine, dopamine, selective serotonin reuptake inhibitors, SSRIs, tricyclic antidepressants, TCAs, norepinephrine, NE, dopamine, DA, suicide, seasonal affective disorder, SAD, antidepressants, lithium, psychotherapy, substance abuse, alcohol abuse, drug abuse
