Introduction: Globally, over a million lives are lost to suicide annually. Though reliable national statistics are lacking, available data suggest that the rates of suicide in Nigeria may be comparable to global patterns. Engagement of patients who have contemplated or attempted suicide in treatment could reduce their risk of recidivism and completed suicide. The Emergency Department (ED) has been identified as a thoroughfare for suicidal patients; it is therefore a strategic site for implementing interventions targeted at engaging suicidal patients in treatment. Literature search revealed scarcity of data on interventions targeted at engaging suicidal patients in treatment, in an African setting.
Objective: This study assessed the effect of an ED-based intervention on treatment engagement (compliance with out-patient appointment) among patients with history of suicidal attempt, 3 months after discharge from the ED to an out-patient clinic in Nigeria.
Method: The study was conducted at the ED of the Federal Neuro-Psychiatric Hospital Yaba, the only 24-hour facility based Psychiatric emergency services in Lagos, Nigeria. Following comprehensive psychiatric evaluation patients with history of suicidal attempts (n=32 in each group) were randomly assigned to a ‘treatment as usual’ group (Group A) and an intervention group (Group B) before discharge from the ED to the out-patient clinic. Continuity of compliance with out-patient clinic appointments was followed up for 3 months from the point of discharge from the ED. Intervention for patients in Group B included problem solving/supportive counselling, access to 24-hour phone contact of a Psychiatrist and systematic telephone contact by a key worker.
Results: There were no significant differences in the socio-demographic and clinical characteristics of patients in both groups at baseline. At 3 months post-discharge from the ED, the patients in the intervention group were more likely to be engaged in services, as compared with Group A where the majority had dropped out of treatment (OR=3.71, p<0 xss=removed>
Conclusion: Interventions initiated in the emergency department can successfully engage suicidal patients in treatment, in the short term. Further studies on a larger sample are needed to confirm and extend these findings in the long-term. ED treatment for suicidal patients should be scaled up from routine triage care to include interventions targeted at facilitating treatment engagement.