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Introduction: Suicidality is a growing problem in the US, and the emergency department (ED) is often the front line for the management and effective treatment of acutely suicidal patients. There is a dearth of interventions that emergency physicians may use to manage and effectively treat acutely suicidal patients. To the extent that recently described interventions are available for ED personnel, no review has been conducted to identify them. This scoping review is intended to fill this gap by systematically reviewing the literature to identify recently described interventions that can be administered in the ED to reduce symptoms and stabilize patients.Methods: We conducted a search of PubMed, SCOPUS, and CINAHL in January 2024 to identify papers published between 2013–2023 for original research trialing recent interventions for the effective treatment of suicidality in the ED. We assessed 16 full-text articles for eligibility, and nine met inclusion criteria. Included studies were evaluated for features and characteristics, the fit of the intervention to the ED environment, and interventional efficacy.Results: Four studies assessed the efficacy of a single dose of the anesthetic/analgesic agent ketamine. Three studies assessed the efficacy of a brief psychosocial intervention delivered in the ED, two of which paired this intervention with the provision of follow-up care (postcard contact and referral assistance/case management, respectively). The remaining two studies trialed a brief, motivational interviewing-based intervention. Included studies had strong experimental designs (randomized controlled trials) but small sample sizes (average 57). Among the interventions represented across these nine studies, a single dose of ketamine and the brief psychosocial intervention Crisis Response Planning (CRP) show promise as ED-appropriate interventions for suicidality. Ketamine and CRP demonstrated the strongest fit to the ED environment and most robust efficacy findings.Conclusion: This review identified one drug (ketamine) and four unique psychological/behavioral interventions that have been used to treat acute suicidality in the ED. There is currently insufficient evidence to suggest that these interventions will prove efficacious and well-suited to be delivered in the ED environment. Future studies should continue to test these interventions in the ED setting to determine their feasibility and efficacy.

The Alaska Native Collaborative Hub for Research on Resilience (ANCHRR) engages Indigenous leadership at all levels in a strength-based study to deepen our understanding of community level protective factors in Indigenous communities, which are the collective influences shaping individual wellbeing across time. Overall, ANCHRR aims to position Alaska Native Tribes, Tribal organizations, and community members as the guides for culturally responsive research that is aligned with community priorities of increasing resilience and wellbeing among Alaska Native youth and reducing their suicide risk. Our approach brings together Indigenous knowledge and research methods that humbly draw attention to the solutions that already exist within communities. An Indigenous paradigm shifts the approach from a singular focus on individuals and their risks and deficits to appreciation for the cultural, community, and systemic ways in which community members support, care for, and guide their young people into adulthood. We describe the lessons learned about this unique approach to Indigenous leadership and community engagement and discuss the research processes that keep the relational heart-work at the center of every project activity. This capacity-building, mutually beneficial and relational approach offers new insights to knowledge development endeavors.

Despite ample anecdotal evidence, there are limited meaningful studies speaking to the important role of the human-animal bond (HAB) in reducing suicidality. However, research is increasingly showing the viability of service dogs (SDs) as a complementary approach for military Veterans suffering from post-traumatic stress disorder (PTSD) and substance use harms – two of the strongest indicators of suicidality across any population. An original, exploratory study completed in 2020 focused on how SDs supported Canadian Veterans living with PTSD and substance use concerns. From this work, a secondary analysis was then undertaken: 28 transcripts were examined through thematic analysis to explore the experiences of the Veterans who were identified as being at high risk for suicide to better understand how SDs may assist with their suicidality. Our methodological approach for the secondary analysis employed affective coding to discover how the social support system enabled by the SDs reduced experiences of loneliness and hopelessness, as well as symptoms of PTSD, depression, and substance use concerns that are commonly associated with suicidality. The SDs were reported by the Veterans as being a catalyst in reducing self-harm and suicidality, as the HAB provided a unique and necessary form of social support for Veterans that was distinct from what other human-human interactions could provide. While acknowledgement of how context specificity and the lived experience of each individual remains crucial for making sense of suicidality, the significant finding from this research has been the identification of the critical impact that SDs have in the lives of Veterans when it comes to preventing suicide. The SD has been explained as a bridge to improve Veterans’ overall quality of life and reduce markers commonly recognized as precursors to suicide – a finding that may be critical in helping reduce future suicide risk among military Veterans, and warrants further investigation.

BackgroundThe rates of suicide and opioid use disorder (OUD) among pregnant and postpartum women continue to increase. This research characterized OUD and suicide attempts among Medicaid-enrolled perinatal women and examined prenatal OUD diagnosis as a marker for postpartum suicide attempts.MethodsData from Oregon birth certificates, Medicaid eligibility and claims files, and hospital discharge records were linked and analyzed. The sample included Oregon Medicaid women aged 15-44 who became pregnant and gave live births between January 2008 and January 2016 (N = 61,481). Key measures included indicators of suicide attempts (separately for any means and opioid poisoning) and OUD diagnosis, separately assessed during pregnancy and the one-year postpartum period. Probit regression was used to examine the overall relationship between prenatal OUD diagnosis and postpartum suicide attempts. A simultaneous equations model was employed to explore the link between prenatal OUD diagnosis and postpartum suicide attempts, mediated by postpartum OUD diagnosis.ResultsThirty-three prenatal suicide attempts by any means were identified. Postpartum suicide attempts were more frequent with 58 attempts, corresponding to a rate of 94.3 attempts per 100,000. Of these attempts, 79% (46 attempts) involved opioid poisoning. A total of 1,799 unique women (4.6% of the sample) were diagnosed with OUD either during pregnancy or one-year postpartum with 53% receiving the diagnosis postpartum. Postpartum suicide attempts by opioid poisoning increased from 55.5 per 100,000 in 2009 to 105.1 per 100,000 in 2016. The rate of prenatal OUD also almost doubled over the same period. Prenatal OUD diagnosis was associated with a 0.15%-point increase in the probability of suicide attempts by opioid poisoning within the first year postpartum. This increase reflects a three-fold increase compared to the rate for women without a prenatal OUD diagnosis. A prenatal OUD diagnosis was significantly associated with an elevated risk of postpartum suicide attempts by opioid poisoning via a postpartum OUD diagnosis.ConclusionsThe risk of suicide attempt by opioid poisoning is elevated for Medicaid-enrolled reproductive-age women during pregnancy and postpartum. Women diagnosed with prenatal OUD may face an increased risk of postpartum suicides attempts involving opioid poisoning.