Introduction
The topic of this study is the prevention of suicide attempts leading to the death of patients and medical personnel in emergency department. The main concern of the study is the fact that patient or staff suicide has a high chance of occurring in the emergency department, and effective measures must be taken to prevent such cases. The emergency department must comply with all safety measures, including for people with mental health problems. However, suicide can occur due to a chaotic environment, high workload, confirmation of the diagnosis, and lack of care.
Providing timely intervention and protection for patients and staff exhibiting behavioral despair is a challenge in the emergency department due to a shortage of staff and supplies. The main goal of this study is to develop a system for immediate response and suicide prevention in the emergency department. To develop a system, it is necessary to find ways to recognize early signs of suicidal behavior. The latest statistical data and theoretical literature are used to confirm the significance and relevance of the study.
Theoretical Base Justification
Research needs to focus on a theoretical framework that provides statistical and descriptive data regarding suicide attempts in emergency departments. It is necessary to rely on existing approaches in assessing the suicidality of individual groups of people and the overall indicator. These data are required to develop appropriate scoring models to reduce the level of suicidal risk. The theoretical basis for communication with individuals who are at risk of suicidal behavior is necessary to justify the measures to reduce the number of suicides, providing an understanding of the reasons for such cases.
A separate body of the studied literature concerns the specifics of suicidal behavior among medical personnel in the United States. One concept for further study is post-traumatic stress disorder, described in the theoretical literature. Turning to such a source will allow the research to rely on the possible prerequisites for suicidal behavior in more detail. Literature on the management of suicidal tendencies is needed to develop a future strategy for help and prevention. It is necessary to draw on the literature on suicide and mental illness among physicians, including the emergency department. From such studies, it is possible to trace the main risk factors for an increase in suicides and develop a strategy for leveling them. It is worth emphasizing that the work used both general studies of suicidal behavior and private ones, concerning high risks of suicides in emergency departments.
Significance and Relevance of the Problem
Suicide is one of the most common causes of death in the United States, and therefore is a global problem that requires special attention. A lot of research has been devoted to reducing suicidal risks, but the specificity of suicides in the emergency department has not yet been clearly and precisely defined. The research problem is relevant, since the topic of suicide is extremely important, and the protection of patients and doctors should be a main task. The emergency room should be the safest place possible, and identifying the causes of increased risk and finding ways to resolve them should be a priority. The study will make a significant contribution to the practice of patient care, as it will allow the development of a rapid response system to ensure the safety of clients. The development of a system for identifying and reducing risks will be an additional layer of protection. The study will develop an effective system that promotes the safety of doctors. In this way, public health will become safer for all parties involved.
Literature Review
Basic Concepts
The main concepts of the studied literature include the risks of developing traumatic and suicidal behavior in patients and doctors, the specifics of the dynamics in the emergency department, and the methodology of work and possible solutions to this problem. All researchers recognize the high risks of increased suicidal behavior. For patients, the risks may be associated with stress and adverse news, or a severe course of illness. The risk of suicide in doctors increases due to high workload, high responsibility, stress and reduced motivation. Young and old people are most at risk of forming suicidal behavior. The problem requires immediate intervention and the development of a concept for patients and medical staff protection.
Generalization on the Subject of Suicide
Medical staff and patients in emergency departments have a high rate of suicidal behavior associated with a complex and multifactorial phenomenon. A study by Canner et al. (2018) attempts to recognize the causes of the high number of suicide attempts resulting in the death of patients and staff in emergency departments and to propose preventive solutions. Young people aged 15–19 were the most affected by age demographics, while women were the most affected in terms of gender (Canner et al., 2018). Older people may be at a separate risk group due to a greater number of comorbidities, affecting the moral state.
Emergency Department
Researchers highlight the seriousness of the problem of increased suicidal risk in the emergency department. Individuals presenting to the emergency department show symptoms of intentional self-harm and suicidal behavior. A study by Canner et al. (2018), using samples from the National Emergency Management Services (NEDS), found that between 2006 and 2013, there were 3,567,084 suicide attempts associated with emergency room visits. The results of the study inform of the severity of emergency department-related self-harm among patients who have been attending hospitals over the years (Canner et al., 2018). A further research question should concern causative factors and indicators of suicide among patients who have been in the emergency department.
Patients
The main risk group among patients are the elderly and young people. Older people are more receptive to changing situations due to greater somatic receptivity. Costanza et al. (2020) describe why older people visiting emergency departments are a high-risk factor for suicide based on enrollment cohorts. Psychiatric comorbidities are common among the elderly and play a significant role (Costanza et al., 2020). The high cost of emergency hospitalization causes depression and suicidal thoughts in older patients. Costanza et al. (2019) shows that the elderly are at high risk due to comorbidities and existing health complications. Drawing on the literature, the study will propose technical and policy solutions for managing the prevalence of suicide among patients following emergency department visits.
Medical Professionals
Studies have shown that not only patients visiting emergency rooms are at high suicidal risk. Stehman et al. (2019) found that emergency physicians are at the highest risk of suicide among healthcare workers. Burnout is a major cause of other psychological problems that lead to suicide. Intolerance for errors in emergency departments, irregular work hours, and duty expose emergency personnel to high rates of burnout. Although burnout is a psychological syndrome, it is not the only risk factor for suicidal thoughts in emergency room staff.
Determining the factors behind high suicide rates among emergency room workers will highlight the administrative and environmental aspects that lead to high suicide rates. An evidence-based review by Harvey et al. (2019) highlights that physicians’ unregulated work environment, workload, support organizations, and mental well-being have led to an increase in reports of suicide. Harvey et al. (2019) provide an overview of comprehensive aspects of the physician workplace, ethical and mental stability, ranging from training to organizational level interventions. DeLucia et al. (2019) found that suicide rates among healthcare workers are affected by workplace stressors and traumatic events. Emergency medical workers deal with critically injured patients, which can be highly psychologically traumatic experience.
Research Context, Venue and Methodology
The basis of research on the topic of suicidal risks among patients and doctors in the emergency department is statistics. Canner et al. (2018) and Costanza et al. (2020) provide statistics on the prevalence of suicide among patients leaving the emergency department and the underlying causes. The researches highlight possible ways to reduce the existing problem. Using the virtual collaborative suicide assessment and management system is a viable tool to promote technology-assisted care to reduce suicide rates among patients and emergency department staff (Dimeff et al., 2020). Both studies by Dimeff et al. (2020) and DeLucia et al. (2019) concluded that screening for symptoms of suicidal behavior and getting to the emergency room contributes to thoughts of self-harm among patients. All of the studies take place in the emergency department and report the same high suicidal risk. The methodology includes mainly quantitative studies to identify the causes of suicide and increased risk. Likewise, further research will rely on statistical data to identify possible solutions. An effective tool is the satisfaction survey of patients and medical employees.
Design and Methodology
Methodology
To conduct the research, a clear methodology is needed to defend the general concepts of the proposed study to reduce suicidal risks. Firstly, the study involves the use of a quantitative method. It is proposed to compile and conduct a survey on suicidal risks among patients and medical personnel of the emergency department. This method will identify the real causes and gradually eliminate them. It is necessary to record the number of people in a depressed emotional state and analyze the reasons for such conditions.
Method of Data Collection and Analysis
The method of data collection is a questionnaire survey of patients and professionals of the emergency department. Additional psychological testing, such as the Beck Depression Scale, is suggested to determine whether there are suicidal risks associated with depression. Psychological testing will be preceded in a format of a questionnaire survey. Questionnaires will be different for patients and physicians in an emergency department. The list of questions for doctors is proposed to include:
- Do you experience stress associated with working in the emergency department?
- What motivates you to continue working?
- Have you ever thought about leaving this job?
- What do you think is the main reason for your stress in the workplace?
- Do you feel that you are experiencing professional burnout?
Questions for the patients are proposed to be slightly different:
- Are you satisfied with the level of attention provided in the emergency department?
- Do you experience stress from being in an emergency care unit?
- Do you see an increase in anxiety levels before and after being admitted to the hospital?
- Do you think your stress level will decrease after living the emergency department?
- What specifically might cause you anxiety when you arrive at the hospital?
The analysis of the obtained results is supposed to be interpreted in quantitative terms. The number of positive and negative responses will be obtained to determine if there is a general trend. Interpretation will also be given in the qualitative response: it is expected that patients and doctors will answer questions about what causes stress in the emergency department. In this way, the main factors that can create suicidal risks will be identified. The result of psychological testing will be obtained in quantitative terms, it will be possible to identify the average risk of depression among both patients and doctors.
Method Justification
The main principle of determining the method for the study is to protect the participants of the survey from undesirable consequences. Questionnaires can provoke participants to suicidal thoughts and reflect on their experience in a negative way. That is the reason why the questionnaire does not directly specify whether participants have suicidal thoughts. Therefore, it is proposed to use the Beck Scale, aimed at identifying depression and not directly asking about thoughts that increase suicidal risks. This technique simultaneously helps protect participants and obtain research-relevant data.
Research Design
Conditions, Sampling, and Defining Variables
The main variable for the study is the satisfaction of emergency department staff and patients. The level of satisfaction is planned to be measured in correlation with the stress experienced, both in the case of patients and staff. The sample will consist of long-term working doctors and patients at risk. The risk group includes young people under 30 years and elderly patients with concomitant diseases that can have a depressing effect on the psychological state. The sample should be at least 10 people for each category, 20 patients and doctors respectively. Tests for physicians and patients should differ significantly while maintaining a common focus. The questionnaires of doctors will include questions about professional duty, the level of pressure, the ability to cope with responsibility. Patients will be asked about their experience of being in an emergency care unit. The subjects are invited to undergo psychological testing aimed at identifying depressive disorders. Such tests will show how the risks differ, whether there are common features between patients and doctors, what are the main causes of this condition.
Obtaining and Forming Informed Consent
For any medical research involving participants, the informed consent of all those involved is required. Informed consent should be obtained immediately prior to any manipulation. The consent procedure will include a description of the goals and objectives of the study, the requirements for participants, and the benefits derived from the experiment. The informed consent form should reflect the items contained in the participant information that are important to investigators. Items on the informed consent form begin with the participant’s name. When asking a participant for permission to use specific data, this item should be reflected in the text of the Informed Consent Form. The text should contain information about signing two copies of the document.
Informed Consent Form
For the participant of the scientific pilot study “Increased Suicide in Emergency Departments”
- I have read and understood the information provided in this document about this medical research study. I had enough time to decision making; the supervisors in this study explained unclear information to me and fully answered all my questions.
- I hereby certify that I have been fully informed of the risks and potential benefits of my participation in the study.
- I voluntarily agree to participate in this study without any pressure.
- I authorize the researcher and/or research team to process my medical data for research purposes, as well as the transfer of this data in an anonymized form.
- I agree to make my medical records available to official authorized persons, subject to the rules of confidentiality of personal data.
- I have been provided with a signed and dated copy of the Participant Information Sheet and Informed Consent Form for participation in the study. I understand that the record of my consent to participate in the study will be kept in medical records.
Reliability
The study will be trustable because it relies on a sufficient ranking of participants. A broad theoretical base allows the research to state that this technique is reliable for obtaining relevant results. Data will be collected directly from people in emergency department conditions. This will clearly identify the reasons why there is an increased risk of suicidal behavior among medical staff and patients. Subsequently, this will help the development of a clear intervention strategy that will be based on data from real people experiencing relevant cases.
Limitations
The study has limitations based on the subjectivity of the questionnaire data obtained. The varying levels of emotional resilience and ability to cope with stress in participants may underestimate the resulting overall level of suicidal risk. Participants may be afraid to openly reflect on such topics, which provokes people involved not to be completely honest. The number of participants may be too small to get a wide range of results.
Ethical Considerations
Every research, for ethical reasons, should aim not only to obtain relevant results, but to ensure the safety of research participants. Therefore, before questioning and psychological testing, it is necessary to fully identify the risks of participating in the study. Participants should be clearly explained that testing may be associated with an increased risk of suicidal behavior. To comply with ethical standards, it is necessary to ensure the complete anonymity of participants. Anonymity will allow participants to feel safe and be more open about personal questions. The results of the research must be used solely for medical purposes and for the benefit of the community.
Conclusion
Suicidal behavior among patients and physicians in emergency department is a serious problem requiring intervention. To address this problem, it is proposed to conduct a study based on a survey of those involved in the functioning of the emergency department. The questionnaire will be aimed at identifying common suicidal risks, as well as the reasons that may cause such thoughts and actions. For more relevant research results, participants in the experiment will take the Beck Depression Scale, which will show a quantitative result. Once the actual level of suicidal risk and possible causes have been identified, a strategy is needed to address this problem.
References
Canner, J. K., Giuliano, K., Selvarajah, S., Hammond, E. R., & Schneider, E. B. (2018). Emergency department visits for attempted suicide and self-harm in the USA: 2006–2013. Epidemiology and psychiatric sciences, 27(1), 94-102. Web.
Costanza, A., Amerio, A., Radomska, M., Ambrosetti, J., Di Marco, S., Prelati, M., Aguglia, A., Serafini, G., Amore, M., Bondolfi G. & Pompili, M. (2020). Suicidality assessment of the elderly with physical illness in the emergency department. Frontiers in psychiatry, 11, 558974. Web.
DeLucia, J. A., Bitter, C., Fitzgerald, J., Greenberg, M., Dalwari, P., & Buchanan, P. (2019). Prevalence of post-traumatic stress disorder in emergency physicians in the United States. Western journal of emergency medicine, 20(5), 740. Web.
Dimeff, L. A., Jobes, D. A., Chalker, S. A., Piehl, B. M., Duvivier, L. L., Lok, B. C., & Koerner, K. (2020). A novel engagement of suicidality in the emergency department: Virtual Collaborative Assessment and Management of Suicidality. General hospital psychiatry, 63, 119-126.
Harvey, S. B., Epstein, R. M., Glozier, N., Petrie, K., Strudwick, J., Gayed, A., Dean, K. & Henderson, M. (2021). Mental illness and suicide among physicians. The Lancet, 398(10303), 920-930. Web.
Stehman, C. R., Testo, Z., Gershaw, R. S., & Kellogg, A. R. (2019). Burnout, drop out, suicide: physician loss in emergency medicine, part I. Western Journal of Emergency Medicine, 20(3), 485. Web.