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The Role of Suicide Risk in the Decision for Psychiatric Hospitalization After a Suicide Attempt

Published Online: Doi: https://doi.org/10.1027/0227-5910/a000050

Background: Suicide prevention can be improved by knowing which variables physicians take into account when considering hospitalization or discharge of patients who have attempted suicide. Aims: To test whether suicide risk is an adequate explanatory variable for predicting admission to a psychiatric unit after a suicide attempt. Methods: Analyses of 840 clinical records of patients who had attempted suicide (66.3% women) at four public general hospitals in Madrid (Spain). Results: 180 (21.4%) patients were admitted to psychiatric units. Logistic regression analyses showed that explanatory variables predicting admission were: male gender; previous psychiatric hospitalization; psychiatric disorder; not having a substance-related disorder; use of a lethal method; delay until discovery of more than one hour; previous attempts; suicidal ideation; high suicidal planning; and lack of verbalization of adequate criticism of the attempt. Conclusions: Suicide risk appears to be an adequate explanatory variable for predicting the decision to admit a patient to a psychiatric ward after a suicide attempt, although the introduction of other variables improves the model. These results provide additional information regarding factors involved in everyday medical practice in emergency settings.

References

  • American Psychiatric Association Steering Committee on Practice Guidelines . (2003). Practice guideline for the assessment and treatment of patients with suicidal behaviors. American Journal of Psychiatry, 160, 1–60. First citation in articleCrossrefGoogle Scholar

  • Baca-Garcia, E. , Diaz-Sastre, C. , Resa, E. G. , Blasco, H. , Conesa, D. B. , Saiz-Ruiz, J. , de Leon, J. (2004). Variables associated with hospitalization decisions by emergency psychiatrists after a patient’s suicide attempt. Psychiatric Services, 55, 792–797. First citation in articleCrossref MedlineGoogle Scholar

  • Baca-Garcia, E. , Perez-Rodriguez, M. M. , Basurte-Villamor, I. , Saiz-Ruiz, J. , Leiva-Murillo, J. M. , de Prado-Cumplido, M. , ... de Leon, J. (2006). Using data mining to explore complex clinical decisions: A study of hospitalization after a suicide attempt. Journal of Clinical Psychiatry, 67, 1124–1132. First citation in articleCrossref MedlineGoogle Scholar

  • Bennewith, O. , Gunnell, D. , Peters, T. , Hawton, K. , House, A. (2004). Variations in the hospital management of self-harm in adults in England: Observational study. British Medical Journal, 328, 1108–1109. First citation in articleCrossref MedlineGoogle Scholar

  • Canadian Coalition for Senior’s Mental Health . (2006). The assessment of suicide risk and prevention of suicide. Toronto, ON: Canadian Colation for Senior’s Mental Health. First citation in articleGoogle Scholar

  • Galfalvy, H. C. , Oquendo, M. A. , Mann, J. J. (2008). Evaluation of clinical prognostic models for suicide attempts after a major depressive episode. Acta Psychiatrica Scandinavica, 117, 244–252. First citation in articleCrossref MedlineGoogle Scholar

  • Goldberg, J. F. , Ernst, C. L. , Bird, S. (2007). Predicting hospitalization versus discharge of suicidal patients presenting to a psychiatric emergency service. Psychiatric Services, 58, 561–565. First citation in articleCrossref MedlineGoogle Scholar

  • Hawton, K. , van Heeringen, K. (2009). Suicide. Lancet, 373, 1372–1381. First citation in articleCrossref MedlineGoogle Scholar

  • Hepp, U. , Moergeli, H. , Trier, S. N. , Milos, G. , Schnyder, U. (2004). Attempted suicide: Factors leading to hospitalization. Canadian Journal of Psychiatry, 49, 736–742. First citation in articleCrossref MedlineGoogle Scholar

  • Isacsson, G. , Rich, C. L. (2001). Management of patients who deliberately harm themselves. British Medical Journal, 322, 213–215. First citation in articleCrossref MedlineGoogle Scholar

  • Johannessen, H. A. , Dieserud, G. , Jakhelln, F. , Zahl, P. H. , De, L. D. (2009). Changes in institutional psychiatric care and suicidal behavior: A follow-up study of inpatient suicide attempters in Baerum, Norway. Social Psychiatry and Psychiatric Epidemiology, 44, 845–851. First citation in articleCrossref MedlineGoogle Scholar

  • Kapur, N. , House, A. , Creed, F. , Feldman, E. , Friedman, T. , Guthrie, E. (1998). Management of deliberate self-poisoning in adults in four teaching hospitals: Descriptive study. British Medical Journal, 316, 831–832. First citation in articleCrossref MedlineGoogle Scholar

  • Miret, M. , Nuevo, R. , Ayuso-Mateos, J. L. (2009). Documentation of suicide risk assessment in clinical records. Psychiatric Services, 60, 994. First citation in articleCrossref MedlineGoogle Scholar

  • Miret, M. , Nuevo, R. , Morant, C. , Sainz-Corton, E. , Jiménez-Arriero, M. A. , López-Ibor, J. J. , ... Ayuso-Mateos, J. L. (2010). Quality of the written information about suicide attempters. Revista de Psiquiatria y Salud Mental, 3, 13–18. First citation in articleCrossref MedlineGoogle Scholar

  • National Institute for Clinical Excellence . (2004). The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. London, UK: Author. First citation in articleGoogle Scholar

  • New Zealand Guidelines Group (NZGG) and Ministry of Health . (2003). The assessment and management of people at risk of suicide. Wellington: New Zealand Guidelines Group (NZGG) and Ministry of Health. First citation in articleGoogle Scholar

  • O’Brien, R. M. (2007). A caution regarding rules of thumb of variance inflation factors. Quality and Quantity, 41, 673–690. First citation in articleCrossrefGoogle Scholar

  • Owens, D. , Dennis, M. , Jones, S. , Dove, A. , Dave, S. (1991). Self-poisoning patients discharged from accident and emergency: Risk factors and outcome. Journal of the Royal College of Physicians London, 25, 218–222. First citation in articleMedlineGoogle Scholar

  • Schmidtke, A. , Bille-Brahe, U. , De Leo, D. , Kerkhof, A. E. (2004). Suicidal behavior in Europe. Results from the WHO/EURO Multicentre Study of Suicidal Behavior. Göttingen: Hogrefe & Huber. First citation in articleGoogle Scholar

  • Schnyder, U. , Valach, L. (1997). Suicide attempters in a psychiatric emergency room population. General Hospital Psychiatry, 19, 119–129. First citation in articleCrossref MedlineGoogle Scholar

  • Silverman, M. M. , Berman, A. L. , Sanddal, N. D. , O’Carroll, P. W. , & Joiner, T. E. (2007). Rebuilding the tower of Babel: A revised nomenclature for the study of suicide and suicidal behaviors. Part 2: Suicide-related ideations, communications, and behaviors. Suicide and Life Threatening Behavior, 37, 264–277. First citation in articleCrossref MedlineGoogle Scholar

  • StataCorp . (2007). Stata statistical software: Release 10 [Computer software]. College Station, TX: StataCorp LP. First citation in articleGoogle Scholar

  • Suicide Risk Advisory Committee of the Risk Management Foundation of the Harvard Medical Institutions . (1996). Guidelines for identification, assessment, and treatment planning for suicidality. Boston, MA: Risk Management Foundation of the Harvard Medical Institutions, Inc. First citation in articleGoogle Scholar

  • Suokas, J. , Suominen, K. , Lönnqvist, J. (2009). The attitudes of emergency staff toward attempted suicide patients: A comparative study before and after establishment of a psychiatric consultation service. Crisis, 30, 161–165. First citation in articleLinkGoogle Scholar

  • Suominen, K. , Isometsa, E. , Suokas, J. , Haukka, J. , Achte, K. , Lönnqvist, J. (2004). Completed suicide after a suicide attempt: A 37-year follow-up study. American Journal of Psychiatry, 161, 562–563. First citation in articleCrossref MedlineGoogle Scholar

  • Suominen, K. , Lönnqvist, J. (2006). Determinants of psychiatric hospitalization after attempted suicide. General Hospital Psychiatry, 28, 424–430. First citation in articleCrossref MedlineGoogle Scholar

  • Weisman, A. D. , Worden, J. W. (1972). Risk-rescue rating in suicide assessment. Archives of General Psychiatry, 26, 553–560. First citation in articleCrossref MedlineGoogle Scholar

  • World Health Organization . (1998). International Classification of Diseases (ICD 9). Geneva: Author. First citation in articleGoogle Scholar

  • World Health Organization . (2000). Preventing suicide: A resource for general physicians. Geneva: Author. First citation in articleGoogle Scholar

  • World Health Organization . (2002). Multisite Intervention Study on Suicidal Behaviors-SUPRE-MISS. Geneva: Author. First citation in articleGoogle Scholar

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