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Experiences of substance-using suicidal males who present frequently to the emergency department

Published online by Cambridge University Press:  21 May 2015

Julia M. Spence*
Affiliation:
Emergency Department, St. Michael's Hospital, University of Toronto, Toronto, Ont. Centre for Research on Inner City Health, the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ont. Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ont.
Yvonne Bergmans
Affiliation:
Suicide Studies Unit of the Arthur Sommer Rotenberg Chair in Suicide Studies, St. Michael's Hospital, University of Toronto, Toronto, Ont. Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ont.
Carol Strike
Affiliation:
Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ont. Centre for Addiction and Mental Health, Toronto, Ont. Department of Public Health Sciences, Faculty of Medicine, University of Toronto, Toronto, Ont.
Paul S. Links
Affiliation:
Centre for Research on Inner City Health, the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ont. Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ont.
Jeffrey S. Ball
Affiliation:
Suicide Studies Unit of the Arthur Sommer Rotenberg Chair in Suicide Studies, St. Michael's Hospital, University of Toronto, Toronto, Ont.
Anne E. Rhodes
Affiliation:
Centre for Research on Inner City Health, the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ont. Suicide Studies Unit of the Arthur Sommer Rotenberg Chair in Suicide Studies, St. Michael's Hospital, University of Toronto, Toronto, Ont. Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ont. Department of Public Health Sciences, Faculty of Medicine, University of Toronto, Toronto, Ont. Institute for Clinical Evaluative Sciences, Toronto, Ont.
William J. Watson
Affiliation:
Department of Family and Community Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ont.
Rahel Eynan
Affiliation:
Suicide Studies Unit of the Arthur Sommer Rotenberg Chair in Suicide Studies, St. Michael's Hospital, University of Toronto, Toronto, Ont.
Claire Rufo
Affiliation:
Centre for Addiction and Mental Health, Toronto, Ont.
*
Department of Emergency Medicine, St. Michael's Hospital, 30 Bond St., Toronto ON M5B 1W8; spencej@smh.toronto.on.ca

Abstract

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Objective:

This qualitative study investigated the repeated use of the emergency department (ED) by men with a history of suicidal behaviour and substance abuse to understand the needs and barriers to care for this high-risk group. Identification of common themes from interviews with patients and health care workers can serve as a basis for improved ED-based interventions.

Methods:

Using semistructured interviews, patients, ED staff and family physicians were asked about needs of the aformentioned group. Twenty-five patients were interviewed and completed questionnaires regarding their substance use, aggression, parasuicidal behaviour, alexithymia and childhood trauma. In addition, 27 staff members were interviewed. Interviews were tape-recorded, transcribed and qualitatively analyzed using an iterative coding process.

Results:

Of the 25 patients, 23 (96%) had a mood or anxiety disorder and 18 (75%) had borderline personality disorder. One-half of the patients scored high and another quarter scored moderate on alexithymia testing. The ED was viewed as a last resort despite seeking help. Frustration was felt by both patients and staff regarding difficult communication, especially during an acute crisis.

Conclusion:

The ED plays an important role in the provision of care for men with recurrent suicidal behaviour and substance abuse. Some of the diagnoses and problems faced by these patients are beyond the purview of the ED; however, staff can identify mutual goals for crisis interventions, allow for frequent communication and seek to de-escalate situations through the validation of the stress patients are experiencing.

Type
Original Research • Recherche originale
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

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