Suicide attempters in a psychiatric emergency room population

The aim of this study was to describe the characteristics of psychiatric emergencies when the precipitating event for the emergency room visit was a suicide attempt, compared with other reasons for admission.

For 1 year, all consultations (N = 1438) of a psychiatric emergency service were documented in a detailed questionnaire covering sociodemographic and diagnostic data as well as information about the consultation and the disposition decision. In 163 consultations, deliberate self-harm with possible fatal outcome was the precipitating event. In order to control for diagnosis, all emergency consultations with an adjustment disorder were analyzed in a second step (N = 366). In this subgroup, deliberate self-harm was the precipitating event in 78 cases.

Compared with the other emergencies, the suicide attempters were better integrated in the occupational as well as in private life. They were more often referred by others, and significant others such as relatives and friends were more frequently involved in the consultation. Nevertheless, the suicide attempters were significantly more often hospitalized. By and large, the same results were found when analyzing the consultations with adjustment disorders only. However, within a ligh-risk subgroup of suicide attempters, no differences with regard to disposition decision were found.

Clinicians should not automatically refer suicide attempters for inpatient treatment, particularly in low-risk patients and when the suicidal intent and the lethality of the suicidal act are not too threatening. Residents should be instructed more thoroughly in suicidology before being assigned to the emergency room.