SUICIDE ATTEMPTERS IN A PSYCHIATRIC EMERGENCY ROOM POPULATION

Objective: The aim of this study was to describe the characteristics o f psychiatric emergencies when the precipitating event for the emergen cy room visit was a suicide attempt, compared with other reasons for a dmission. Method: For 1 year, all consultations (N = 1438) of a psychi atric emergency service were documented in a detailed questionnaire co vering sociodemographic and diagnostic data as well as information abo ut the consultation and the disposition decision. In 163 consultations , deliberate self-harm with possible fatal outcome was the precipitati ng event. In order to control for diagnosis, all emergency consultatio ns 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. Results: Compared with the other emergencies, the suicide attempters were better integrated in the occupational as well as in p rivate 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 significan tly move often hospitalized. By and large, the same results were found when analyzing the consultations with adjustment disorders only. Howe ver, within a high-risk subgroup of suicide attempters, no differences with regard to disposition decision were found. Conclusion: Clinician s should not automatically refer suicide attempters for inpatient trea tment, particularly in low-risk patients and when the suicidal intent and the lethality of the suicidal act are not too threatening. Residen ts should be instructed more thoroughly in suicidology before being as signed to the emergency room. (C) 1997 Elsevier Science Inc.