Suicidality and hospitalization as cause and outcome of pediatric psychiatric emergency room visits

Abstract

The aim of this study was to identify predictors of suicidality in youth presenting to a pediatric psychiatric emergency room service (PPERS). To this end, we conducted a retrospective cohort study of youth aged <18 years consecutively assessed by a PPERS 01.01.2002-12.31.2002, using a 12-page semi-structured institutional evaluation form and the Columbia Classification Algorithm for Suicide Assessment. Multivariate regression analyses were conducted to identify correlates of suicidal thoughts and attempts/preparation and their relationship to outpatient/inpatient disposition. Of 1,062 youth, 265 (25.0%) presented with suicidal ideation (16.2%) or attempt/preparation (8.8%). Suicidal ideation was associated with female sex, depression, adjustment disorder, absent referral by family/friend/self, school referral, precipitant of peer conflict, and no antipsychotic treatment (p < 0.0001). Suicidal attempt/preparation was associated with female sex, depression, lower GAF score, past suicide attempt, precipitant of peer conflict, and no stimulant treatment (p < 0.0001). Compared to suicidal attempt/preparation, suicidal ideation was associated with school referral, and higher GAF score (p < 0.0001). Of the 265 patients with suicidality, 58.5% were discharged home (ideation = 72.1% vs. attempt/preparation = 33.7%, p < 0.0001). In patients with suicidal ideation, outpatient disposition was associated with higher GAF score, school referral, and adjustment disorder (p < 0.0001). In patients with suicidal attempt/preparation, outpatient disposition was associated with higher GAF score, lower acuity rating, and school referral (p < 0.0001). Suicidality is common among PPERS evaluations. Higher GAF score and school referral distinguished suicidal ideation from suicidal attempt/preparation and was associated with outpatient disposition in both presentations. Increased education of referral sources and establishment of different non-PPERS evaluation systems may improve identification of non-emergent suicidal presentations and encourage more appropriate outpatient referrals.

Predictors and Outcomes of Psychiatric Hospitalization in Youth Presenting to the Emergency Department with Suicidality

“…In this sample, 70% of youths were hospitalized after presenting with either suicidal ideation or behavior to an ED, while approximately 30% were sent home. This discharge rate is lower than a recently reported sample of 265 suicidal adolescents, in which 58.5% were discharged home (Grudnikoff et al., ). This higher rate of hospitalization in our sample may be related to the chosen sites for the study.…”

Predictors of voluntary and compulsory admissions after psychiatric emergency consultation in youth

“…The fact that an unstable family situation proved to be a predictor of emergency admission adds to the findings of previous studies. Two factors increased the chance that a child would be admitted after emergency consultation: the parents' absence from the consultation and if a child's having been adopted [15,16]. Similarly, the risk of psychiatric hospitalization of children in regular psychiatric outpatient care has been found to be influenced by a family's level of distress, parental capacity to contain the child, and the primary caregivers' marital status [32,33].…”

“…Various studies have identified demographic characteristics and clinical factors as predictors of voluntary admission of young patients seen in psychiatric crisis situations [15][16][17][18]. Demographic characteristics that were found to be associated with decisions to hospitalize children and adolescents after emergency consultation were relatively older age, minority status, and having been adopted [16][17][18][19]. Clinical factors that were associated with a higher chance of admission were suicide attempt or self-injurious behavior, the clinician's appraisal of high suicide risk, the presence of a depressive or bipolar disorder, the severity of psychiatric symptoms, comorbidity, a lower score on the global assessment of functioning (GAF), and prior admission.…”

“…Clinical factors that were associated with a higher chance of admission were suicide attempt or self-injurious behavior, the clinician's appraisal of high suicide risk, the presence of a depressive or bipolar disorder, the severity of psychiatric symptoms, comorbidity, a lower score on the global assessment of functioning (GAF), and prior admission. The likelihood of hospitalization was also increased by a prior emergency consultation, substance abuse or dependence, and being on psychotropic medication [15][16][17][18][19]. However, both these demographic characteristics and the clinical factors cannot be modified to prevent emergency admissions.…”

“…Contextual characteristics that were found to be associated with the decision to hospitalize children and adolescents after emergency consultation were the absence of parents at consultation; the time and day of consultation (there being a greater chance of admission at night and in school weeks rather than during school holidays); and a rural location [15,17,18]. The source of referral was also associated with the decision to hospitalize: in cases of self-referral and referral by a family member or someone from a school, there was less chance of admission [16].…”