Experiences of substance-using suicidal males who present frequently to the emergency department.(EM Advances)

Publication: Canadian Journal of Emergency Medicine

Publication Date: 01-JUL-08

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COPYRIGHT 2008 Canadian Medical Association

ABSTRACT

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.

Keywords: suicide, emergency, substance use

Conclusion : La salle d'urgence joue un role important dans la prestation de soins aux hommes presentant des antecedents de comportement suicidaire et de chimiodependance. Or, certains diagnostics et problemes auxquels font face ces patients ne sont pas du ressort de l'urgence. Le personnel peut cependant cerner des objectifs mutuels quant a l'intervention en situation de crise, faciliter la communication frequente et chercher a desamorcer la situation en reconnaissant le stress que les patients ressentent.

RESUME

Objectif : Notre etude qualitative portait sur les visites repetees a l'urgence par des hommes presentant des antecedents de comportement suicidaire et de chimiodependance. Nous cherchions a comprendre les besoins de ce groupe a haut risque et les obstacles aux soins. La determination de themes communs par voie d'entretiens avec les patients et les travailleurs de la sante peut servir de fondement pour ameliorer les interventions a l'urgence.

Methodes : Dans le cadre d'entrevues semi-structurees, nous avons pose des questions au personnel de l'urgence et aux medecins de famille sur les besoins de ce groupe a haut risque. Nous avons egalement interviewe 25 patients, qui ont aussi rempli des questionnaires concernant leur consommation abusive d'alcool ou de drogues, les agressions, les comportements parasuicidaires, l'alexithymie et des traumatismes dans leur enfance. De plus, 27 membres du personnel ont ete interviewes. Les entretiens ont ete enregistres, transcrits et analyses qualitativement a l'aide d'un processus de codage iteratif.

Resultats : Des 25 patients de l'etude, 23 (96 %) presentaient un trouble de l'humeur ou un trouble anxieux et 18 (75 %) etaient atteints d'un trouble de la personnalite limite. La moitie des patients ont obtenu un score eleve a l'egard de l'alexithymie et un autre quart a obtenu un score modere a ce sujet. Meme si les patients reconnaissaient avoir besoin d'aide, ils consideraient la salle d'urgence comme leur dernier recours. Tant les patients que le personnel ressentaient de la frustration concernant des communications difficiles, tout particulierement en situation de crise aigue.

Introduction

Patients presenting with mental health and substance abuse problems account for a significant proportion of all emergency department (ED) visits. (1) These patients are often perceived by ED staff as a burden on resources and difficult to treat. (2-5) Staff responses toward repeat visitors with self-injury can include frustration and anger, which ultimately lead to a reduction of empathy and further stigmatization. (6)

For men aged 10 to 49 years, suicide remains one of the leading causes of death, (7) and the risk increases with concurrent diagnoses of alcohol and substance abuse (8,9) (Rhodes et al., unpublished data, 2001). Such patients frequently seek mental health care through EDs (10) despite the fact that many have a family physician. Men report a cyclic pattern of care marked by unpleasant health care experiences, which can exacerbate symptoms and lead to further avoidance of care until a crisis necessitates intervention. Negative health care experiences in the ED may worsen this already fragmented pattern of care (10) for young men with substance abuse and suicide-related behaviours.

This qualitative study was undertaken to investigate the experiences and substance abuse history of men with a history of recurrent ED visits for suicide-related behaviour and to understand the experiences of the health care workers who provide their care. In addition, through the use of previously described methodological approaches, (11,12) we sought to...

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