Do all children with suicidal ideation receive a significant psychiatric intervention?

In most physicians' minds, suicidal ideation carries with it an ominous prognosis requiring intensive evaluation and treatment. The aim of this study was therefore to determine the proportion of children identified with suicide ideation who received a significant psychiatric intervention.

Medical records were reviewed for psychiatric interventions of all children presenting to the emergency department (ED) with behavioral disorders between 2004 and 2007, for whom a psychiatry consultation was obtained. Suicidal children were those who had expressed suicidal ideation. Significant psychiatric intervention was defined as one of the following: hospitalization in a psychiatric facility, period of observation in the ED (≥ 12 h), use of restraints, and prescription of psychiatric medication. Suicidal labeling was considered appropriate if one or more of the aforementioned interventions were recommended by a psychiatrist. The presence of psychiatric intervention was compared with that in children who presented with a behavioral disorder, not labeled as suicidal. Chi-squared or Fisher's exact test, whenever appropriate, was used to evaluate the association between suicide status and intervention.

A total of 160 children (27.1%) were labeled as suicidal, and 431 (72.9%) with a behavioral disorder were classified as non-suicidal. A total of 244/431 (56.6%) in the non-suicidal group had a significant psychiatric intervention compared to 79/160 (49.4%) in the suicidal ideation group (P = 0.116). This 49.4% is significantly different from an a priori assumption that 100% of children with suicidal ideation would have a significant psychiatric intervention.

More than half (50.6%) of the children presenting with a label of suicidal ideation did not receive significant psychiatric intervention. This study calls into question the accuracy of suicide labeling in children referred to the ED.