Predicting hospitalization versus discharge of suicidal patients presenting to a psychiatric emergency service

Psychiatr Serv. 2007 Apr;58(4):561-5. doi: 10.1176/ps.2007.58.4.561.

Abstract

Objective: Suicidal ideation frequently prompts visits to psychiatric emergency departments, and more information is needed about factors that mediate clinicians' decisions to hospitalize or discharge patients with suicidal ideation.

Methods: The authors reviewed records for 257 patients presenting with suicidal ideation to a psychiatric emergency service. Demographic and clinical correlates of hospitalization were examined by backward stepwise binary logistic regression.

Results: Hospitalization occurred for 70% of suicidal persons and was significantly associated with psychosis, a history of attempted suicide, and a suicidal plan. With potential confounding factors controlled, these variables correctly classified 80% of hospitalization decisions.

Conclusions: Psychosis, past suicide attempts, and the presence of a suicide plan robustly predicted the decision to hospitalize suicidal persons seen in psychiatric emergency services. Diagnosis, pharmacotherapy, having a psychiatrist, and insurance subtype were unrelated to hospitalization decisions, suggesting that psychiatric emergency department staff perceive few alternatives to hospitalization when psychosis and suicide plans accompany suicidal ideation.

MeSH terms

  • Adult
  • Aged
  • Ambulatory Care / statistics & numerical data
  • Comorbidity
  • Emergency Services, Psychiatric / statistics & numerical data*
  • Female
  • Hospitalization / statistics & numerical data*
  • Hospitals, Community
  • Hospitals, Teaching
  • Humans
  • Male
  • Massachusetts
  • Mental Disorders / diagnosis
  • Mental Disorders / epidemiology
  • Middle Aged
  • Patient Discharge / statistics & numerical data*
  • Psychotic Disorders / diagnosis
  • Psychotic Disorders / epidemiology
  • Referral and Consultation / statistics & numerical data
  • Retrospective Studies
  • Statistics as Topic
  • Suicide / prevention & control*
  • Suicide / psychology
  • Suicide, Attempted / prevention & control
  • Suicide, Attempted / psychology
  • Suicide, Attempted / statistics & numerical data