605 - Teens’ Experiences with Emergency Department Evaluation for Suicidal Thoughts and Behaviors: A Qualitative Study

Publication Number: 1582.605

Jennifer A.. Hoffmann, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Connor E. Karwowski, Ann & Robert H. Lurie Children's Hospital of Chicago, Elmhurst, IL, United States; Kathryn (Callie) C. Kaplan, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Danielle Cory, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Elizabeth Alpern, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Rinad S.. Beidas, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Scott Compton, Lurie Children's Hospital, Chicago, IL, United States; John Walkup, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Jeffrey Bridge, Nationwide Children's Abigail Wexner Research Institute, Columbus, OH, United States; Jacqueline Grupp-Phelan, University of California, San Francisco, San Rafael, CA, United States; Sara J.. Landes, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Andrea K.. Graham, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States

Background: Emergency departments (EDs) are often the first point of contact for adolescents with suicidal thoughts and behaviors (STBs), yet little is known about how adolescents experience ED evaluations for suicide risk and the transition home. Understanding adolescent perspectives can inform efforts to make ED environments more therapeutic and improve post-discharge support.

Objective: To explore the experiences, perceptions, and needs of adolescents evaluated for STBs during and following an ED visit.

Design/Methods: Semi-structured interviews were conducted with adolescents aged 12-17 years who had an ED visit for evaluation of STBs within the previous three months. Interviews were conducted as part of a larger research study to design a text message-based suicide prevention intervention. Interviews explored perceptions of staff interactions, the ED environment and processes, and post-discharge supports. Interviews were completed via videoconference. Transcripts were audio recorded, professionally transcribed, and analyzed using rapid qualitative analysis methods to identify key themes and exemplar quotes.

Results: We interviewed 12 adolescents with a recent ED visit for STBs (67% female, 50% 12-14 years old). Adolescents' experience of their ED visit was enhanced by staff kindness and respect, while adolescents also identified opportunities to improve communication and offer distraction during long wait times. Environmental safety measures were viewed as both protective and stigmatizing. Considering the post-ED experience, adolescents appreciated immediate support from mental health professionals. They identified that unconditional support from family promotes healing, and that coordinated planning eases the transition back to school (Table).

Conclusion(s): Adolescents' experiences during and after an ED visit for STBs are shaped by interpersonal interactions and environmental conditions. Interventions to enhance staff compassion, improve the wait time experience, and implement safety measures that preserve dignity may improve adolescents' experience of an ED evaluation for STBs. Following an ED visit, interventions that promote immediate linkage to mental health services, bolster family support, and facilitate the transition back to school may enhance recovery after a suicide crisis.

Themes Identified by Adolescents Evaluated for Suicidal Thoughts and Behaviors Regarding their Experience in the Emergency Department and Following Discharge