Implementing psychological care in emergency departments for suicide prevention

Table 1 Comparative analysis of evidence-based psychological interventions for suicide attempters in emergency department settings

Intervention type	Core components	Target population	Duration/format	Key efficacy findings	Implementation considerations
SPI	Collaborative development of personalized crisis response plan; means restriction counseling; identification of warning signs and coping strategies	All suicide attempters presenting to ED	Single session (20-45 minutes); often combined with follow-up contacts	Odds ratio: 0.51 for suicide attempts vs usual care[4]; 43%-86% reduction in suicide-related ED visits in DBT programs[29]	Can be delivered by trained nurses, social workers, or peers; requires standardized training and fidelity monitoring
Cognitive behavioral therapy	Cognitive restructuring; problem-solving skills; emotion regulation; behavioral activation	High-risk patients with recurrent attempts or severe ideation	6-12 sessions (individual or group); may be initiated in ED with community referral	Odds ratio: 0.54 for repeat attempts[5]; 41% reduced risk via telehealth delivery[27]	Requires specialized therapists; may involve task-shifting with supervision; telehealth adaptations show promise[20]
DBT	Mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness skills	Patients with borderline personality traits, chronic suicidality, or emotion dysregulation	Comprehensive program (individual therapy, skills group, phone coaching, team consultation)	Significant reductions in suicide attempts and self-harm[33]; digital DBT shows feasibility[15]	Resource-intensive; requires specialized training; digital adaptations may increase accessibility[33]
Brief contact interventions	Postcards, letters, phone calls, text messages; caring contacts; systematic follow-up	All suicide attempters post-discharge	Multiple contacts over 6-12 months (e.g., 24-48 hours, 1 week, 1 month, 3 months, 6 months)	24% reduced risk of relapse with early appointment scheduling[31]; active contact reduces repeat attempts within 6 months[30]	Low-cost; can be automated or delivered by non-specialists; requires systematic tracking system[56,57]
Attempted Suicide Short Intervention Program	Therapeutic alliance building; narrative reconstruction; safety planning; follow-up letters	First-time and repeat suicide attempters	3-4 sessions plus follow-up letters over 24 months	Reduced suicide reattempts by 80% at 24-month follow-up[55]	Brief format (3 sessions); manualized; requires therapist training[55]

SPI: Safety planning intervention; ED: Emergency department; DBT: Dialectical behavior therapy.