Transition to suicide ideation and attempt among emergency room patients

Abstract

Background Suicidal thoughts and behaviours (STB) represent a persistent and serious public health problem, and suicide is among the leading causes of death worldwide. We focus on predictors of transition rates and time courses through the STB spectrum among psychiatric emergency room (PER) patients. Aims We aimed to investigate (a) whether currently suicidal patients had prior referrals to the PER, (b) for which reason they were previously referred to the PER and (c) the timing of this referral. Method We performed a retrospective study spanning 20 years with 24 815 PER referrals. Descriptive statistics of patients’ sociodemographic and clinical characteristics are provided and expressed as weighted proportions and means. Logistic regression was used to identify risk profiles of patients who had a higher chance of being referred for reasons of STB given their PER history. Multiple imputation and data weighting techniques were implemented. Results STB among PER patients was persistent and led to repeated referrals (up to five times more likely), often within a short period (18% <1 month). Those previously referred for ideation/plan had 66% higher risk of making the transition to suicide attempt, with 25% making this transition within a month after previous referral. This is similar to the transition from depressed mood to suicide ideation/plan. Conclusions STBs in PER patients are persistent and lead to repeated referrals, often within a short period, including transitions to more severe forms of STB.

Keywords

• Suicidal thoughts and behaviours
• depression
• primary care
• psychiatric emergency room
• public health