Dr. Saskia Mérelle

Senior researcher at 113 Suicide Prevention, Amsterdam, The Netherlands


Challenges faced by nurses and physicians in acute care for patients who attempted suicide

Objective: To examine issues in care for patients who come to the emergency department after a suicide attempt.

Design: Cross-sectional multicentre questionnaire survey.

Method: In 2015, 7 emergency departments across the Netherlands participated in a questionnaire survey of the 113 Suicide Prevention (113 Zelfmoordpreventie) service as a part of the 2014-2017 National Suicide Prevention Agenda. Emergency physicians and nurses and managers answered 25 multiple-choice questions about: (a) current treatment of and contact with patients who attempted suicide, (b) available knowledge and skills of emergency physicians and nurses and (c) after-care for patients who attempted suicide.

Results: In total, 33 emergency physicians, 40 emergency nurses and 5 managers completed the questionnaire. When a patient comes to the emergency department after a suicide attempt, emergency physicians and nurses often consult with the crisis service, psychiatrist or a colleague and they request extra diagnostics. The most important issue indicated by emergency staff is that they do not have enough time, knowledge and skills to estimate the suicide risk and to conduct a conversation with the patient about her or his suicidal thoughts. One-fifth of the respondents indicated that they do not always treat patients who committed a previous suicide attempt with respect. The respondents also thought that the emergency department environment is too restless or unsafe and thought that they have to wait for the crisis service for a long time. The majority of the emergency physicians and nurses worried about the condition of the patient after her or his discharge, especially when they estimate a high probability of another suicide attempt.

Conclusion: Insufficient knowledge and skills of emergency department staff, a sometimes negative attitude towards people who attempted suicide and a heavy workload are hindering care at the emergency department for people who attempted suicide. Targeted training, a quiet area and deployment of specialised care could improve this care.


Dr. S.Y.M. (Saskia) Mérelle. Since August 2017 Saskia works as a senior researcher for the research department of 113 Suicide Prevention to support their mission: aiming for Zero Suicides in the Netherlands. Her key interests are epidemiology, suicide prevention among youth, innovative technological research in helplines and psychological autopsy studies. She was originally trained in Human Movement Sciences and Clinical Epidemiology, did her PhD at Erasmus MC and Utrecht University and worked as an epidemiologist at the Public Health Service (GGD) of Kennemerland..

Some publications

Mérelle SYM, Boerema I, van der Linden MC, Gilissen R. Knelpunten in SEH-zorg voor suïcidepogers [Issues in emergency care for people who attempted suicide]. Ned Tijdschr Geneeskd. 2018 Jul 2;162:D2463. Dutch. PMID: 30040297.

Mérelle S, Van Bergen D, Looijmans M, Balt E, Rasing S, van Domburgh L, Nauta M, Sijperda O, Mulder W, Gilissen R, Franx G, Creemers D, Popma A. A multi-method psychological autopsy study on youth suicides in the Netherlands in 2017: Feasibility, main outcomes, and recommendations. PLoS One. 2020 Aug 27;15(8):e0238031. doi: 10.1371/journal.pone.0238031. PMID: 32853213; PMCID: PMC7451645.

Salmi S, Mérelle S, Gilissen R, Brinkman WP. Content-Based Recommender Support System for Counselors in a Suicide Prevention Chat Helpline: Design and Evaluation Study. J Med Internet Res. 2021 Jan 7;23(1):e21690. doi: 10.2196/21690. PMID: 33410755; PMCID: PMC7819775.

Mérelle S, Foppen E, Gilissen R, Mokkenstorm J, Cluitmans R, Van Ballegooijen W. Characteristics Associated with Non-Disclosure of Suicidal Ideation in Adults. Int J Environ Res Public Health. 2018 May 9;15(5):943. doi: 10.3390/ijerph15050943. PMID: 29747408; PMCID: PMC5981982.

Balt E, Mérelle S, van Bergen D, Gilissen R, van der Post P, Looijmans M, Creemers D, Rasing S, Mulder W, van Domburgh L, Popma A. Gender differences in suicide-related communication of young suicide victims. PLoS One. 2021 May 21;16(5):e0252028. doi: 10.1371/journal.pone.0252028. PMID: 34019584; PMCID: PMC8139476.

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