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Patients on Involuntary Hold Status in the Emergency Department.

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Patients requiring involuntary holds in suburban emergency departments (EDs) often have psychiatric and substance use disorders. Suicidal ideation was the most frequent reason for holds, with suicide attempters showing fewer medical comorbidities.

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Area of Science:

  • Psychiatry
  • Emergency Medicine
  • Public Health

Background:

  • Involuntary holds are common in emergency departments (EDs).
  • Existing research primarily focuses on urban academic centers.
  • Understanding suburban ED populations is crucial for targeted interventions.

Purpose of the Study:

  • To characterize demographic and clinical features of patients on involuntary holds in a suburban ED.
  • To compare patients who attempted suicide with other involuntary patients.

Main Methods:

  • Retrospective review of medical records for patients on involuntary hold status.
  • Data collected: demographics, medical and psychiatric comorbidities, violence, readmissions, and mortality.
  • Subanalysis comparing suicide attempters to non-attempters.

Main Results:

  • 85.3% had psychiatric disorders (depression most common), 43% had substance use disorders.
  • Suicidal ideation (73.7%) was the primary reason for hold; 25.1% attempted suicide.
  • Suicide attempters had fewer opiate users and medical disorders compared to other involuntary patients.

Conclusions:

  • Suburban involuntary patients differ from urban counterparts in sex and psychiatric diagnoses but share high rates of substance misuse.
  • Suicidal ideation and attempts are leading causes for involuntary holds.
  • Demographic and clinical profiles of suicide attempters are largely similar to other involuntary patients.