Coexistence of Substance Abuse among Emergency Department Patients Presenting with Suicidal Ideation.

BACKGROUND: Patients who are suicidal commonly seek care in the emergency department (ED). Few studies have examined the coexistence between suicidal ideation, substance abuse, and psychiatric diagnosis. OBJECTIVES: This study sought to determine how often suicidal ED patients have coexisting substance abuse and psychiatric diagnosis in addition to describing the characteristics of target population. METHODS: In this retrospective cohort study, chart reviews were conducted of patients over 12 with suicidal ideation who presented to an academic ED from October 2016 to March 2017. Data abstracted included gender, age, insurance, prior psychiatric diagnoses, substances abused, presence of a suicide attempt, prior suicidality, number of ED visits in the prior year, and disposition. Both descriptive and inferential statistics were calculated. RESULTS: There were 427 patient visits to the ED for suicidality during the study period, of which 54% were male, with a mean age of 34 years. Most patients (92%) had a psychiatric diagnosis, most commonly depression (67%). More than one psychiatric diagnosis was reported in 51% of patients, while 8% had no reported underlying psychiatric diagnosis. Substance abuse was reported in 58% of patients, including marijuana (42%) and opioids (41%). Polysubstance abuse was reported in 42%. Approximately half of the patients had three or more ED visits in the previous 12 months. Most patients were insured by Medicaid (51%), while 59% were admitted for inpatient treatment. CONCLUSION: Substance abuse and psychiatric diagnosis were reported frequently among patients presenting to the ED with suicidal ideation, often involving more than one substance/diagnosis. Future studies should be aimed at evaluating the relationship between these conditions and determining how to better care for this population.

Antecedents of fatigue, close calls, and crashes among commercial motor-vehicle drivers.

PROBLEM: Minimizing driver fatigue among commercial motor-vehicle (CMV) drivers is a major safety issue in the United States. This study examines the effects of potentially fatigue-inducing factors inherent in truck driving work and company safety management in explaining: (a) drivers driving while fatigued, (b) the frequency of close calls due to fatigue, and (c) actual crashes among CMV drivers. METHOD: Data for this study are derived from a survey of CMV drivers in 116 trucking firms, with all data being driver-reported. The relative roles of fatigue-inducing factors and safety management practices in explaining variation in fatigue, close calls, and crashes are reported, along with the roles of fatigue in affecting close calls and crashes via hierarchical regression. RESULTS: Findings indicated that fatigue-inducing factors inherent in driving work and safety practices accounted for appreciable variation in driving fatigued (R(2) =.42) and close calls (R(2) =.35), but not crash involvement. Driving while fatigued also accounted for incremental increases in the amount of variation in close calls, after consideration of inherent factors and safety practices. IMPACT ON INDUSTRY: Findings indicate that safety practices (e.g., establishment of a strong safety culture, dispatcher scheduling practices, company assistance with fatiguing behaviors such as loading and unloading) have considerable potential to offset fatigue-inducing factors associated with truck driving work.

Management practices as antecedents of safety culture within the trucking industry: similarities and differences by hierarchical level.

PROBLEM: A homogeneous perception of safety is important for the achievement of a strong safety culture; however, employees may differ in their safety perceptions, depending on their position and/or hierarchical level within the organization. Moreover, there is limited information on the antecedents of safety culture. This study examines how safety training, driver scheduling autonomy, opportunity for safety input, and management commitment to safety influence individuals' perceptions of safety culture. METHOD: Data for this study were drawn from 116 trucking firms, stratified by three safety performance levels. The data were collected from drivers (lowest hierarchical level), dispatchers (medium hierarchical level), and safety directors (highest hierarchical level), regarding their perceptions of their respective corporate safety cultures. Perceptions of safety culture were analyzed through a linear regression using dummy variables to differentiate among the three hierarchical groups. The resulting model allowed for examination of the specific antecedents of safety culture for the three employee groups and the extent to which the hierarchical groups were in agreement with each other. RESULTS: Driver fatigue training, driver opportunity for safety input, and top management commitment to safety were perceived to be integral determinants of safety culture in all three groups. IMPACT ON INDUSTRY: Trucking firms seeking to strengthen employees' perceptions of safety culture might begin by improving these safety management practices while appreciating that they may have a different impact depending on the employee's hierarchical position (e.g., drivers' perceptions of safety culture are more influenced by top management commitment and driver fatigue training). A fourth safety practice examined, driver scheduling autonomy, was not found to be instrumental in shaping safety culture for any of the three hierarchical levels. Consistent with previous research, implementation of stronger safety cultures should result in fewer accidents.