Biomaterial Database

Predicting hospitalization versus discharge of suicidal patients presenting to a psychiatric emergency service. 2007

Joseph F Goldberg, and Carrie L Ernst, and Suzanne Bird

Affective Disorders Program, Silver Hill Hospital, 208 Valley Rd., New Canaan, CT 06840, USA. jfgoldberg@yahoo.com

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.

UI	MeSH Term	Description	Entries
D008297	Male		Males
D008404	Massachusetts	State bounded on the north by New Hampshire and Vermont, on the east by the Atlantic Ocean, on the south by Connecticut and Rhode Island, and on the west by New York.
D008875	Middle Aged	An adult aged 45 - 64 years.	Middle Age
D010351	Patient Discharge	The administrative process of discharging the patient, alive or dead, from hospitals or other health facilities.	Discharge Planning,Discharge Plannings,Discharge, Patient,Discharges, Patient,Patient Discharges,Planning, Discharge,Plannings, Discharge
D011618	Psychotic Disorders	Disorders in which there is a loss of ego boundaries or a gross impairment in reality testing with delusions or prominent hallucinations. (From DSM-IV, 1994)	Psychoses,Psychosis, Brief Reactive,Schizoaffective Disorder,Schizophreniform Disorders,Psychosis,Brief Reactive Psychoses,Brief Reactive Psychosis,Disorder, Psychotic,Disorder, Schizoaffective,Disorder, Schizophreniform,Disorders, Psychotic,Disorders, Schizoaffective,Disorders, Schizophreniform,Psychoses, Brief Reactive,Psychotic Disorder,Reactive Psychoses, Brief,Reactive Psychosis, Brief,Schizoaffective Disorders,Schizophreniform Disorder
D012017	Referral and Consultation	The practice of sending a patient to another program or practitioner for services or advice which the referring source is not prepared to provide.	Consultation,Gatekeepers, Health Service,Hospital Referral,Second Opinion,Consultation and Referral,Health Service Gatekeepers,Hospital Referrals,Referral,Referral, Hospital,Referrals, Hospital,Consultations,Gatekeeper, Health Service,Health Service Gatekeeper,Opinion, Second,Opinions, Second,Referrals,Second Opinions
D004637	Emergency Services, Psychiatric	Organized services to provide immediate psychiatric care to patients with acute psychological disturbances.	Emergency Psychiatric Services,Psychiatric Emergency Services,Services, Emergency Psychiatric,Services, Psychiatric Emergency,Emergency Psychiatric Service,Emergency Service, Psychiatric,Psychiatric Emergency Service,Psychiatric Service, Emergency,Psychiatric Services, Emergency,Service, Emergency Psychiatric,Service, Psychiatric Emergency
D005260	Female		Females
D006760	Hospitalization	The confinement of a patient in a hospital.	Hospitalizations
D006764	Hospitals, Community	Institutions with permanent facilities and organized medical staff which provide the full range of hospital services primarily to a neighborhood area.	Community Hospital,Community Hospitals,Hospital, Community