James Donaldson on Mental Health – Understanding traumatic injuries and suicide risk: A conceptual exploration for the emergency department

By Y.T. Thomas, A.C. Swann, S. Murtaza, T.R. Kosten, N. Murphy, S.J. Mathew, C.D. Verrico, J. Davis 

Highlights

• •Emergency departments serve as vital touchpoints for public health intervention in mental health and suicidality.
• •Repeated trauma intensifies impulsivity, heightening suicide risk.
• •Impulsivity and behavioral sensitization jointly raise suicide risk.
• •Potential ideas to enhance the continuum of care beyond immediate stabilization include integration of a multidisciplinary model to trauma care, digital tools to bridge post-discharge gaps, and data-driven approaches to enhance prevention.

Abstract

Emergency departments (EDs) serve as critical points of care for individuals experiencing acute physical and psychological trauma, including those at heightened risk for suicidal behavior. This article explores the dynamic interplay between traumatic injuries, impulsivity, behavioral sensitization, and suicide risk, with a focus on the exacerbating role of repeated trauma exposure. Impulsivity and sensitization, driven by neurobiological and psychological responses to chronic stress, emerge as critical factors underlying increased vulnerability to suicide, particularly under conditions of perceived uncontrollability. We emphasize the imperative role of EDs in the early identification of at-risk individuals and the implementation of timely, evidence-based interventions that extend beyond immediate stabilization. We highlight potential post-discharge follow-up strategies, including telehealth and digital health technologies, as important components of a continuum of care to provide sustained psychosocial support. A comprehensive, multidisciplinary ED framework is proposed, integrating trauma-informed care, impulsivity-targeted interventions, and advanced data-driven tools to reduce recurrent ED presentations and future suicide attempts. This model underscores the transformative potential of technology and collaboration in optimizing care pathways, improving outcomes, and mitigating the societal burden of suicide.

Introduction

Emergency Departments (EDs) often serve as the first point of contact for individuals presenting with traumatic injuries and acute suicidal behaviors (Betz and Boudreaux, 2016) stemming from unintentional injuries, violence, and intentional self-harm (DiMaggio et al., 2017; Canner et al., 2018). This dual convergence of traumatic injuries and suicidality represents a significant public health challenge, as deliberate and accidental harm frequently coexist in cases of self-inflicted injury (Hawton et al., 2012; O’Connor et al., 2014). The acute nature of these presentations underscores the critical role of EDs in addressing the immediate needs of individuals in crisis while laying the groundwork for longer-term recovery.

Trauma, particularly when severe (e.g., threatened death or sexual violence) or recurrent, exerts profound psychological effects, including post-traumatic stress disorder (PTSD) and other mental health conditions, such as acute stress disorder and depression (Kessler et al., 1995). Such disruptions in emotional regulation increase vulnerability to impulsive behaviors (van der Kolk, 1996; Braquehais et al., 2010), characterized by unplanned actions without regard for potential consequences, which are strongly associated with self-harm and suicide risk (Braquehais et al., 2010; Whiteside and Lynam, 2001). Behavioral sensitization, where repeated exposure to trauma lowers the threshold for intense emotional or physiological responses, compounds this risk (Antelman et al., 1980; Seo et al., 2014; Johnson et al., 2017). This phenomenon makes individuals increasingly prone to suicidal behavior, even in response to relatively minor stressors (Joiner, 2007; Johnson et al., 2017), further complicating their clinical trajectory.

Up to 60?% of suicides occur as first attempts, and as many as 75?% involve individuals without a formal psychiatric diagnosis (Cavanagh et al., 2003; DeJong et al., 2010). This highlights the strategic importance of EDs as critical intervention points, especially for individuals who have not engaged with mental health services before their crisis. In such contexts, timely, evidence-based care within the ED setting can prevent recurrent harm, reduce the likelihood of future suicide attempts, and foster resilience (Miller et al., 2017; Inagaki et al., 2019).

The enduring psychological and physiological impacts of trauma, coupled with the aftermath of suicide attempts, emphasize the need for a comprehensive approach to ED care. Beyond immediate stabilization, effective interventions must incorporate an understanding of each patient’s psychosocial context to extend into long-term support and rehabilitation (Miller et al., 2017; Boudreaux et al., 2023). Since stress perceived as inescapable is a key driver of sensitized behavior (Dickerson and Kemeny, 2004; Maier and Seligman, 2016), stress-reframing interventions are a critical aspect of ED protocols, promoting resilience and mitigating risk (Johnson et al., 2015).

Therefore, the ED is a vital nexus for public health intervention in mental health and suicidality, requiring a paradigm shift going beyond acute care to a multidisciplinary, integrated model. By combining medical treatment, mental health assessment, and psychosocial support, EDs have the potential to transform outcomes for individuals in crisis, addressing the complex interplay of trauma, impulsivity, and suicidal risk with precision and compassion.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson’s latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

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The intersection of trauma, impulsivity, and suicidal risk

Trauma significantly elevates the risk of suicidal behavior, particularly in individuals exhibiting impulsivity and behavioral sensitization (Klonsky and May, 2015). Impulsivity plays a pivotal role in turning momentary crises into life-threatening situations (Whiteside and Lynam, 2001; Simon et al., 2001). Two distinct forms of impulsivity—trait impulsivity and action impulsivity—are critical in understanding this phenomenon. Trait impulsivity refers to a predisposition to act quickly on

Limitations

This manuscript presents an integrated conceptual framework for understanding the relationship between trauma, impulsivity, behavioral sensitization, and suicide risk in emergency department (ED) settings. While this model is informed by empirically supported interventions—such as suicide risk screening (Boudreaux et al., 2016), brief ED-based interventions (Stanley et al., 2018), and structured follow-up protocols (Miller et al., 2017; Knox et al., 2012)—we acknowledge that the framework

Conclusions

The intersection of trauma and suicide risk within the ED setting represents a complex and multifaceted challenge, driven in part by the critical roles of impulsivity and behavioral sensitization. Addressing these mechanisms through a multidisciplinary approach holds significant potential to transform ED care for individuals at heightened risk of suicide. By implementing targeted, evidence-based interventions, leveraging innovative digital and telehealth resources, and fostering seamless