Association between psychiatric hospitalization and suicidal behavior among people presenting to the emergency...

To determine the risk of suicidal behaviors at follow-up among patients with mental disorders seeking help in the emergency department and hospitalized versus those not hospitalized.

Administrative data was used to identify 9606 adults, who presented to the Emergency Department (ED) in Manitoba, Canada between 2009 and 2016 with a mental disorder and a subgroup of 1794 individuals who presented specifically with a suicide attempt. They were followed until 2018 on outcomes of suicide deaths and suicide attempts, comparing those who were hospitalized versus discharged from the ED. Inverse probability of treatment weights (IPTW) were applied in Cox proportional hazards models to adjust for confounding variables including: sex, region, age, income quintile, justice involvement, income assistance, foster care involvement, dispensed psychotropic medications, high school completion, physical comorbidities and suicide attempts.

After adjustment, future hospitalizations for suicide attempts were more likely among individuals who were hospitalized compared to those who were discharged, among both those who presented to the ED with a mental disorder (Hazard Ratio (HR) 3.09, Confidence Interval (CI) [2.70-3.54]) and those who presented specifically with a suicide attempt (HR 2.66, CI [2.20-3.20]). However, there was no statistically significant difference in suicide death rate among those who were hospitalized compared to those who were discharged after presenting with a mental disorder, or suicide attempt specifically.

This study observed a higher risk of suicide attempts with re-hospitalization at follow-up among patients with mental disorders who were initially hospitalized after an emergency department presentation compared to those discharged. These study findings suggest that hospitalization was not associated with risk of suicide. Further research is critical to develop interventions to reduce suicide risk among individuals seeking help in the ED.