Predictive factors for the medical hospitalisation of patients who visited the emergency department with suicide attempt

Tertiary Teaching ◽

Abstract Background Suicide is a significant public health problem. Individuals are estimated to make up to 20 suicide attempts before suicide. The emergency department (ED) is the first location where individuals are brought after a suicide attempt. This study investigated the factors related to delays in the medical hospitalisation of patients who attempted suicide and aimed to provide criteria for hospitalisation decisions by physicians. Methods This study included patients who had deliberately self-harmed (age ≥19 years) and presented at the EDs of two tertiary teaching hospitals between March 2017 and April 2020. Those for whom relevant demographic and clinical information were unavailable and those admitted to the psychiatric wards were excluded. Results This study included 414 patients in the hospitalisation group and 1,346 in the discharged group. The mean patient age was 50.3 ± 20.0 years and 40.7 ± 17.0 years in the hospitalised and discharged groups (p <0.001), respectively. The mean ED length of stay (LOS) was 4.2 ± 12.3 and 11.4 ± 18.8 h in the hospitalised and discharged groups, respectively. In the hospitalised group, the odds ratio and confidence interval for aged 35~64 (2.222, 1.343–3.678), aged over 65 (2.788, 1.416-5.492), sex -male (2.041, 1.302–3.119), and consciousness (1.840, 1.253–2.466). The Risk-Rescue Ratio Scale (RRRS) was (1.298, 1.255–1.343). A receiver operating characteristics analysis of RRRS for the decision to hospitalise patients who attempted suicide showed a cut-off value of 42, with sensitivity, specificity, and area under the curve being 85.7%, 85.5%, and 0.924, respectively.Conclusion The level of consciousness and the RRRS of patients who attempted suicide can be the factors to decide medical hospitalisation and reduce ED LOS and crowding.

Predictive factors for the medical hospitalization of patients who visited to emergency department with suicide attempt

10.21203/rs.3.rs-51267/v2 ◽

2020 ◽

Author(s):

Hye Jin Kim ◽

Duk Hee Lee

Keyword(s):

Emergency Department ◽

Suicide Attempt ◽

Attempted Suicide ◽

Suicide Attempts ◽

Area Under The Curve ◽

Public Health Problem ◽

Teaching Hospitals ◽

Tertiary Teaching ◽

Abstract Background Suicide is a significant public health problem. Individuals are estimated to make up to 20 suicide attempts before suicide. The emergency department (ED) is the first location where individuals are brought after a suicide attempt. This study investigated the factors related to delays in the medical hospitalization of patients who attempted suicide and aimed to provide criteria for hospitalization decisions for physicians. Methods This study included who had deliberately self-harmed (age ≥19 years) and who presented at the EDs of two tertiary teaching hospitals between March 2017 and April 2020. Those for whom relevant demographic and clinical information were unavailable and those who were admitted to the psychiatric wards were excluded. Results This study included 414 patients in the hospitalization group and 1,346 in the discharged group. The mean patient age was 50.3 ± 20.0 years and 40.7 ± 17.0 years in the hospitalized and discharged groups ( p <0.001), respectively. The mean ED length of stay (LOS) was 4.2 ± 12.3 and 11.4 ± 18.8 h in the hospitalized and discharged groups, respectively . In the hospitalized group, the odds ratio and confidence interval for aged 35~64 (2.222, 1.343–3.678), aged over 65 (2.788, 1.416-5.492), sex -male (2.041, 1.302–3.119), and consciousness (1.840, 1.253–2.466). The Risk-Rescue Ratio Scale (RRRS) was (1.298, 1.255–1.343). A receiver operating characteristics analysis of RRRS for the decision to hospitalize patients who attempted suicide showed a cut-off value of 42, with sensitivity, specificity, and area under the curve being 85.7%, 85.5%, and 0.924, respectively. Conclusion The level of consciousness and the RRRS of patients who attempted suicide can be the factors to decide medical hospitalization and reduce ED LOS and crowding.

Predictive factors for the medical hospitalisation of patients who visited the emergency department with suicide attempt

BMC Psychiatry ◽

10.1186/s12888-021-03089-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hye Jin Kim ◽

Duk Hee Lee

Keyword(s):

Emergency Department ◽

Suicide Attempt ◽

Attempted Suicide ◽

Suicide Attempts ◽

Area Under The Curve ◽

Public Health Problem ◽

Teaching Hospitals ◽

Tertiary Teaching ◽

Abstract Background Suicide is a significant public health problem. Individuals are estimated to make up to 20 suicide attempts before suicide. The emergency department (ED) is the first location where individuals are brought after a suicide attempt. This study investigated the factors related to delays in the medical hospitalisation of patients who attempted suicide and aimed to provide criteria for hospitalisation decisions by physicians. Methods This study included patients who had deliberately self-harmed (age ≥ 19 years) and presented at the EDs of two tertiary teaching hospitals between March 2017 and April 2020. Those for whom relevant demographic and clinical information were unavailable and those admitted to the psychiatric wards were excluded. Results This study included 414 patients in the hospitalisation group and 1346 in the discharged group. The mean patient age was 50.3 ± 20.0 years and 40.7 ± 17.0 years in the hospitalised and discharged groups (p < 0.001), respectively. The mean ED length of stay (LOS) was 4.2 ± 12.3 and 11.4 ± 18.8 h in the hospitalised and discharged groups, respectively. In the hospitalised group, the odds ratio and confidence interval for aged 35 ~ 64 (2.222, 1.343–3.678), aged over 65 (2.788, 1.416–5.492), sex -male (2.041, 1.302–3.119), and consciousness (1.840, 1.253–2.466). The Risk-Rescue Ratio Scale (RRRS) was (1.298, 1.255–1.343). A receiver operating characteristics analysis of RRRS for the decision to hospitalise patients who attempted suicide showed a cut-off value of 42, with sensitivity, specificity, and area under the curve being 85.7, 85.5%, and 0.924, respectively. Conclusion The level of consciousness and the RRRS of patients who attempted suicide can be the factors to decide medical hospitalisation and reduce ED LOS and crowding.

Indicators of early hospitalization decision to shorten emergency department length of stay of suicide attempters

10.21203/rs.3.rs-51267/v1 ◽

2020 ◽

Author(s):

Hye Jin Kim ◽

Duk Hee Lee

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Suicide Attempts ◽

Public Health Problem ◽

Psychiatric Ward ◽

Psychiatric Admission ◽

Suicide Attempters ◽

Tertiary Teaching ◽

Abstract Background Suicide attempters contribute to a significant public health problem. Individuals are estimated to make up to 20 suicide attempts before committing suicide. The emergency department (ED) is the first location where suicide attempters are brought. This study investigated the factors associated with early hospitalization decisions to determine the criteria for patient hospitalization rather than psychiatric ward admission and identify measures to shorten ED length of stay (LOS). Methods This study included suicide attempters (age ≥19 years) who visited the EDs at two tertiary teaching hospitals between March 2017 and April 2020. Results A total of 414 in the hospitalization and 1,346 in the discharge groups patients were included. The mean age was 50.3 ± 20.0 years and 40.7 ± 17.0 years in the hospitalization and discharge groups (p <0.001). The mean ED LOS was 4.2 ± 12.3 and 11.4 ± 18.8 h in the hospitalization and discharge groups, respectively. In the hospitalization group, the odds ratio and confidence interval for age (1.017, 1.008–1.026), sex (male) (1.787, 1.127–2.515), consciousness (2.330, 1.653–3.266), and the Risk-Rescue Ratio Scale (RRRS) (1.273, 1.242–1.304) were calculated. A receiver operating characteristics analysis of RRRS for the decision to hospitalize suicide attempters showed a cut-off value of 42, with sensitivity, specificity, and area under the curve of 85.7%, 85.5%, and 0.924, respectively.Conclusion For suicidal attempters in the ED, the decision on medical hospitalization rather than psychiatric admission should be based on their level of consciousness and the RRRS to reduce ED LOS and crowding.

Suicide and Attempted Suicide in Jhenaidah District, Bangladesh, 2010–2018

Crisis ◽

10.1027/0227-5910/a000631 ◽

2020 ◽

Vol 41 (4) ◽

pp. 304-312 ◽

Cited By ~ 3

Author(s):

Anisur Rahman Khan ◽

Kopano Ratele ◽

Najuwa Arendse ◽

Md. Zahidul Islam ◽

Isaac Dery

Keyword(s):

Suicide Attempt ◽

Attempted Suicide ◽

Suicide Attempts ◽

Descriptive Analysis ◽

National Level ◽

Public Health Problem ◽

Routine Data ◽

Suicide Rates ◽

Male Suicide ◽

Survey Estimates

Abstract. Background: Suicide and attempted suicide are a serious but under-explored public health problem in Bangladesh. Survey estimates suggest that Jhenaidah District, one of the 64 districts that make up Bangladesh, is one of the highest suicide-prone regions in Bangladesh. Relatively little is known about the magnitude of suicide attempts in the district. Aims: This article describes the incidence of suicide and suicide attempts for Jhenaidah, Bangladesh for the period 2010–2018. Method: Primary descriptive analysis was performed on routine data collected by a Bangladesh-based nongovernment organization (NGO): Societies for Voluntary Activities (SOVA). Results: A total of 22,675 suicide attempts and 3,152 suicides occurred in the district. The rate of suicide attempts was found to be 136.35/100,000 and the suicide rate was found to be 20.6/100,000 in Jhenaidah. The subdistrict Sadar had the highest incidence of suicide attempt (38.09%) and suicide (33.47%). Poisoning was the most common method of suicide attempt for both males (77.07%) and females (77%). Limitations: Many cases of suicide attempts and suicide are unreported in Bangladesh owing to stigmatization; only reported cases form part of this investigation. Conclusion: Jhenaidah has very high rates of suicide and suicide attempts that surpass the global and Bangladesh averages. Although females demonstrate higher suicide rates, male suicide rates have gradually increased over the study period. Future studies are called for to better understand the local patterns and dynamics of fatal and nonfatal suicidal behaviors. Developing a sub-district-, district-, and national-level suicide prevention strategy ought to be considered a priority.

Characteristics of the Early Post-suicidal Period after Repeat Suicide Attempts in Patients with Mental Disorders

Doctor Ru ◽

10.31550/1727-2378-2020-19-9-59-64 ◽

2020 ◽

Vol 19 (9) ◽

pp. 59-64

Author(s):

N.S. Rutkovskaya ◽

◽

V.K. Shamrey ◽

E.S. Kurasov ◽

A.I. Kolchev ◽

...

Keyword(s):

Mental Disorders ◽

Suicide Attempt ◽

Social Adjustment ◽

Attempted Suicide ◽

Suicide Attempts ◽

Schizophrenia Spectrum Disorders ◽

Study Objective ◽

Study Results ◽

Retrospective Clinical Study ◽

Study Objective: To study characteristics of the early post-suicidal period after suicide attempts in patients with mental disorders. Study Design: This was a retrospective clinical study. Materials and Methods: The study looked at the characteristics of the early post-suicidal period after suicide attempts in a group of 260 subjects with mental disorders (schizophrenia-spectrum disorders, organic, affective, neurotic, addictive, or personality disorders, or intellectual disability). The mean age of patients who attempted suicide was 43.5 ± 17.7 years. The numbers of men and women were almost equal: 134 (51.5%) and 126 (48.5%), respectively (p>0.05). The mean duration of hospitalization was 42.7 ± 43.2 bed-days. The study methods included clinical examinations, psychopathological assessments, psychometrics, and statistical-mathematical methods. Study Results: The authors identified the following main types of early post-suicidal period: the critical type (n = 73, 28.1%) and denial of a suicide attempt (n = 55, 21.2%) were the most common and the analytical type (n = 23, 8.8%) was the least common. The study determined that 77 (29.6%) psychiatric inpatients with a history of attempting suicide made another attempt. The most common methods of attempted suicide in this group of patients included poisoning with medications (n = 41, 53.2%) and self-cutting (n = 26, 33.8%), and 40.3% were under the influence of alcohol at the time of the repeat suicide attempt. Among the patients who made a repeat suicide attempt, manipulative and suicide-fixated types of post-suicidal period were observed significantly more often. Patients with mental disorders who made repeat suicide attempts showed poor social adjustment in their professional life and overall attitude toward life. Conclusion: The characteristics of the post-suicidal period identified in patients with mental disorders who have made a repeat suicide attempt should be taken into consideration when planning and providing secondary preventive mental healthcare services. Further investigation of these characteristics in various groups of patients, combined with a search for predictive factors for repeat suicide attempts, as well as evaluation of the effectiveness of previously provided preventive mental health care, will make it possible to better tailor these services and reduce the overall risk of suicidal behavior in people with mental disorders. Keywords: suicide, repeat suicide attempt, type of post-suicidal period, mental disorder, social adjustment.

Patient-Identified Priorities Leading to Attempted Suicide

Crisis ◽

10.1027/0227-5910/a000473 ◽

2018 ◽

Vol 39 (1) ◽

pp. 37-46 ◽

Cited By ~ 2

Author(s):

Niklaus Stulz ◽

Urs Hepp ◽

Dominic G. Gosoniu ◽

Leticia Grize ◽

Flavio Muheim ◽

...

Keyword(s):

Suicide Attempt ◽

Health Problem ◽

Depressive Disorders ◽

Attempted Suicide ◽

Suicide Attempts ◽

Interpersonal Conflict ◽

Public Health Problem ◽

Major Public Health Problem ◽

Social Interventions ◽

Dsm Iv

Abstract. Background: Attempted suicide is a major public health problem. Aim: The aim of this study was to identify patient-identified problems and triggers typically leading to attempted suicide. Method: A representative sample of 66 adult patients was recruited from all clinical sites and psychiatrists who treat patients after attempted suicide in the Canton of Basel-City (Switzerland). Patients were diagnosed using the Structured Clinical Interview for DSM-IV (SCID) and interviewed with a local adaptation of the Explanatory Model Interview Catalogue (EMIC) to study underlying problems and triggers of attempted suicide. Results: Of the patients, 92.4% had at least one DSM-IV disorder, with depressive disorders being the most prevalent disorder. Although half (50.0%) of the patients identified a health problem, 71.2% identified an interpersonal conflict as underlying problem leading to the suicide attempt. Furthermore, an interpersonal conflict was identified as the trigger of the suicide attempt by more than half of the patients (54.5%). Limitations: The study included German-speaking patients only. Conclusion: According to patients, interpersonal problems often amplify underlying psychiatric problems, leading to suicide attempts. Social and interpersonal stressors should be acknowledged with integrated clinical and social interventions to prevent suicidal behavior in patients and populations.

Analysis of Suicidal Patients Admitted to The Emergency Rooms and Their Intensive Care Requirements, A Double-Center Study in Turkey

10.1101/517417 ◽

2019 ◽

Author(s):

Kocamer Şimşek Betul ◽

Kocamer Şahin Şengül

Keyword(s):

Emergency Department ◽

Domestic Violence ◽

Intensive Care ◽

Suicide Attempt ◽

Suicide Attempts ◽

Demographic Data ◽

Acute Poisoning ◽

Emergency Rooms ◽

Family Issues ◽

AbstractPurposeIn the present study, the clinical and socio-demographic data of the patients who admitted to the emergency department due to suicide attempt, the duration at the emergency department, and hospitalizations are examined. Requirement of intensive care and duration of hospitalization are investigated in the patients with suicide attempt.MethodsPatients who were admitted to the emergency department of the hospitals after suicide attempts between 2015 and 2017 and earlier 2018 were included in the retrospective study. Reason for suicide, suicide modality, duration between the suicide attempt and arrival to the emergency department, suicide time, first treatment at the emergency department, hospitalization, mortality, and the levels at the intensive care unit (ICU) were retrospectively reviewed and analyzed.ResultsIn the present study, 428 patients were included. Ratio of the female to male patients was 319/109. The mean age of the patients was 29.18±10.48. Most of the patients were single. The patients were mostly unemployed. Ninety-four (22.87%) patients were diagnosed with a psychiatric disorder. Four hundred twenty-two (98.59%) of the patients were attempted suicide with drugs/toxics. One hundred ninety-seven patients (49.75%) reported domestic violence and family issues reasons for suicide. Mean duration between the time of suicide and the time to arrive to the emergency department was 100.53±91.82 minutes. One hundred thirty (30.5%) patients were transferred to ICU, and 45 (10.5%) patients were followed in clinical departments. One hundred twenty (92.3%) patients hospitalized in the first-level ICU, 4 (3%) in the second-level ICU, and 6 (4.6%) in the third-level ICU. The mean ICU stay was 2.37±1.48 days.ConclusionThe suicide attempts were prominent in acute poisoning cases. Majority of the patients stated domestic violence and family issues as a reason of suicide. They were discharged mostly from the emergency department and 10.5% of the patients were kept under surveillance in the departments. When the suicide attempts were evaluated in terms of their time, they were observed during day time at a higher rate.

Psychiatric follow up after a suicide attempt

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.714 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s271-s271

Author(s):

D. de la Vega Sánchez ◽

M. Reina Domínguez ◽

S. Fernández León

Keyword(s):

Public Health ◽

Suicide Attempt ◽

Emergency Service ◽

Suicide Attempts ◽

Public Health Problem ◽

Global Public Health ◽

The Mean ◽

Competing Interest ◽

Global Public Health Problem

IntroductionSuicide is a global public health problem. More than 800,000 people die due to suicide every year according to the WHOM. In Spain, about 9 people die due to suicide every day, and the rates increase every year. The presence of previous suicide attempts is one of the strongest risk factors for suicide consumption. Nevertheless, patients sometimes do not receive a correct assistance after a suicide attempt.ObjectiveTo study the follow-up of patients, without previous psychiatrichistory, who commit a first suicide attempt in the area of Huelva (Spain).MethodRetrospective review of the electronic clinical histories of patients attended in the Emergency service of Juan Ramón Jiménez Hospital after a first suicide attempt during the first six months of 2015.ResultsFrom January to June of 2015 we collected a total of 159 patients who committed a firs suicide attempt in our area. A total of 69.18% were women and 30.82 were men. In both sex the mean age was 39 years. Out of the 159 attended after a first suicide attempt, only 54% were referred to the Psychiatry service to be followed up. Out of those referred, only 62% actually attended and only half of them really staying treatment.ConclusionsAn adequate psychiatric follow up after a suicide attempt is needed to reduce the risk of more suicide attempts or consumption. A minority (30.8%) of the patients attended in our area after a first suicide attempt received an adequate attention.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Analysis of suicidal patients admitted to the emergency rooms and their intensive care requirements: A double-center study in Turkey

Medical Science and Discovery ◽

10.36472/msd.v6i10.300 ◽

2019 ◽

Vol 6 (10) ◽

pp. 224-229

Author(s):

Betül Kocamer Şimşek ◽

Şengül Kocamer Şahin

Keyword(s):

Emergency Department ◽

New York ◽

Domestic Violence ◽

Intensive Care ◽

Suicide Attempt ◽

Suicide Attempts ◽

Demographic Data ◽

Acute Poisoning ◽

Family Issues ◽

Objective: In the present study, the clinical and socio-demographic data of the patients who admitted to the emergency department due to suicide attempt, the duration at the emergency department, and hospitalizations are examined. Requirement of intensive care and duration of hospitalization are investigated in the patients with suicide attempt. Materials and Methods: Patients who were admitted to the emergency department of the hospitals after suicide attempts between 2015 and 2017 and per 2018 were included in the retrospective study. Reason for suicide, suicide modality, duration between the suicide attempt and arrival to the emergency department, suicide time, first treatment at the emergency department, hospitalization, mortality, and the levels at the intensive care unit (ICU) were retrospectively reviewed and analyzed. Data obtained from the archives of the hospitals. SPSS 25.0 (IBM Corporation, Armonk, New York, United States) program was used to analyze the variables. Results: In the present study, 428 patients were included. Ratio of the female to male patients was 319/109. The mean age of the patients was 29.18±10.48. 205 patients were single. 136 patients were unemployed. Ninety-four (22.87%) patients were diagnosed with a psychiatric disorder. Four hundred twenty-two (98.59%) of the patients were attempted suicide with drugs/toxics. One hundred ninety-seven patients (49.75%) reported domestic violence and family issues reasons for suicide. Mean duration between the time of suicide and the time to arrive to the emergency department was 100.53±91.82 minutes. One hundred thirty (30.5%) patients were transferred to ICU, and 45 (10.5%) patients were followed in clinical departments. One hundred twenty (92.3%) patients hospitalized in the first-level ICU, 4 (3%) in the second-level ICU, and 6 (4.6%) in the third-level ICU. The mean ICU stay was 2.37±1.48 days. Conclusion: The suicide attempts were prominent in acute poisoning cases. Majority of the patients stated domestic violence and family issues as a reason of suicide. They were discharged mostly from the emergency department and 10.5% of the patients were kept under surveillance in the departments. When the suicide attempts were evaluated in terms of their time, they were observed during day time at a higher rate.

Analysis of Deliberate Self-Wrist-Cutting Episodes Presenting to the Emergency Department

Crisis ◽

10.1027/0227-5910/a000361 ◽

2016 ◽

Vol 37 (2) ◽

pp. 155-160 ◽

Cited By ~ 2

Author(s):

Jin Kim ◽

Han Joon Kim ◽

Soo Hyun Kim ◽

Sang Hoon Oh ◽

Kyu Nam Park

Keyword(s):

Emergency Department ◽

Medical Records ◽

Attempted Suicide ◽

Suicide Attempts ◽

Psychiatric Interview ◽

Clinical Variables ◽

Completed Suicide ◽

Number Of Patients ◽

Group A ◽

Efficacy Of Treatment

Abstract. Background: Previous suicide attempts increase the risk of a completed suicide. However, a large proportion of patients with deliberate self-wrist cutting (DSWC) are often discharged without undergoing a psychiatric interview. Aims: The aims of this study were to investigate the differences in the characteristics and outcomes of patients with DSWC and those with deliberate self-poisoning (DSP) episodes. The results of this study may be used to improve the efficacy of treatment for DSWC patients. Method: We retrospectively reviewed the medical records of 598 patients with DSWC and DSP who were treated at the emergency department of Seoul Saint Mary's Hospital between 2008 and 2013. We assessed sociodemographic information, clinical variables, the reasons for the suicide attempts, and the severity of the suicide attempts. Results: A total of 141 (23.6%) patients were included in the DSWC group, and 457 (76.4%) were included in the DSP group. A significantly greater number of patients in the DSWC group had previously attempted suicide (p = .014). A total of 63 patients (44.7%) in the DSWC group and 409 patients (89.5%) in the DSP group underwent psychiatric interviews. Conclusion: More DSWC patients had previously attempted suicide, but fewer of them underwent psychiatric interviews compared with the DSP patients.