In their Viewpoint, Dr Olfson and colleagues1 called for “enhanced training of emergency physicians in the management of suicidal patients and patients with deliberate self-harm” due to the “shortages of mental health specialists in emergency medical settings.” Studies show that 1 in 5 emergency department patients may be depressed, yet the diagnosis is often missed for a variety of reasons including that patients do not complain of depression but of somatic depression symptoms.2 Similarly, overt suicidal behavior accounts for 0.6% of emergency department visits but the incidental suicidal ideation that is found in 3% to 11.6% of visits is often missed.3 There are 130 million patient visits to emergency departments each year, so there is much room for improvement.4
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