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

Area of Science:

• Pediatric Emergency Medicine
• Child Psychiatry
• Public Health

Background:

• Physicians often associate suicidal ideation in children with a poor prognosis, necessitating intensive evaluation and treatment.
• There is a clinical perception that children identified with suicidal ideation receive significant psychiatric interventions.

Purpose of the Study:

• To determine the proportion of children identified with suicidal ideation who received significant psychiatric intervention in an emergency department setting.
• To compare psychiatric intervention rates between children with and without suicidal ideation labels.

Main Methods:

• Retrospective review of medical records for children (2004-2007) presenting to the emergency department (ED) with behavioral disorders and a psychiatry consultation.
• Significant psychiatric intervention defined as psychiatric hospitalization, prolonged ED observation (≥12h), restraints, or psychiatric medication prescription.
• Chi-squared or Fisher's exact test used to compare intervention rates based on suicide status.

Main Results:

• 160 children (27.1%) were labeled as suicidal; 431 (72.9%) were non-suicidal.
• Only 49.4% of suicidal ideation group children received significant psychiatric intervention, differing from the expectation of 100%.
• Non-suicidal children had a higher rate of significant psychiatric intervention (56.6%) compared to the suicidal ideation group (P=0.116).

Conclusions:

• Over half (50.6%) of children presenting with suicidal ideation did not receive significant psychiatric intervention.
• The findings question the accuracy of suicide labeling for children referred to the ED.
• This highlights a critical gap in the psychiatric care provided to pediatric patients with suicidal ideation.