1
|
McCarthy M, McIntyre J, Nathan R, Saini P. Factors Influencing Emergency Department Staff Decision-Making for People Attending in Suicidal Crisis: A Systematic Review. Arch Suicide Res 2024; 28:35-49. [PMID: 36724348 DOI: 10.1080/13811118.2023.2173113] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Emergency department (ED) staff are often the first point of contact for individuals in suicidal crisis. Despite this, there is no published research systematically examining the factors influencing decision-making for this patient group. METHODS MedLine, CINAHL, PsycINFO, Web of Science and Cochrane Library databases were searched for three key concepts: (1) suicide, (2) accident and emergency department and (3) decision-making. Three reviewers screened titles, abstracts and full papers independently against the eligibility criteria. Data synthesis was achieved by extracting and analyzing study characteristics and findings. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of included studies. RESULTS Seventeen studies met the eligibility criteria and were included in this systematic review. Studies were published from 2004 to 2020 and were of good methodological quality. A number of patient (method of self-harm, age, gender), contextual (availability of services and staff) and staff-related factors (attitudes, training, knowledge) were reported to influence decision-making for patients in suicidal crisis presenting to EDs. CONCLUSION Decision-making in the ED is complex and is influenced by patient, contextual and staff-related factors. These decisions can have an impact on the future care and clinical pathways of patients in suicidal crisis. Additional training is needed for ED staff specifically related to suicide prevention.
Collapse
|
2
|
Witt K, McGill K, Leckning B, Hill NT, Davies BM, Robinson J, Carter G. Global prevalence of psychiatric in- and out-patient treatment following hospital-presenting self-harm: a systematic review and meta-analysis. EClinicalMedicine 2023; 65:102295. [PMID: 37965430 PMCID: PMC10641155 DOI: 10.1016/j.eclinm.2023.102295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Background Hospital-treated self-harm is common, costly, and strongly associated with suicide. Whilst effective psychosocial interventions exist, little is known about what key factors might modify the clinical decision to refer an individual to psychiatric in- and/or out-patient treatment following an episode of hospital-treated self-harm. Methods We searched five electronic databases (CENTRAL, CDSR, MEDLINE, Embase, and PsycINFO) until 3 January 2023 for studies reporting data on either the proportion of patients and/or events that receive a referral and/or discharge to psychiatric in- and/or outpatient treatment after an episode of hospital-treated self-harm. Pooled weighted prevalence estimates were calculated using the random effects model with the Freedman-Tukey double arcsine adjustment in R, version 4.0.5. We also investigated whether several study-level and macro-level factors explained variability for these outcomes using random-effects meta-regression. The protocol of this review was pre-registered with PROSPERO (CRD42021261531). Findings 189 publications, representing 131 unique studies, which reported data on 243,953 individual participants who had engaged in a total of 174,359 episodes of self-harm were included. Samples were drawn from 44 different countries. According to World Bank classifications, most (83.7%) samples were from high income countries. Across the age range, one-quarter of persons were referred for inpatient psychiatric care and, of these, around one-fifth received treatment. Just over one-third were referred to outpatient psychiatric care, whilst around half of those referred received at least one treatment session across the age range. Event rate estimates were generally of a lower magnitude. Subgroup analyses found that older adults (mean sample age: ≥60 years) may be less likely than young people (mean sample age: ≤25 years) and adults (mean sample age: >25 years to <60 years) to be referred for outpatient psychiatric care following self-harm. More recent studies were associated with a small increase in the proportion of presentations (events) that were referred to, and received, psychiatric outpatient treatment. No macro-level factor explained between-study heterogeneity. Interpretation There is considerable scope for improvement in the allocation and provision of both in- and out-patient psychiatric care following hospital-presenting self-harm, particularly considering that the period after discharge from general hospitals represents the peak risk period for repeat self-harm and suicide. Given the marked between-study heterogeneity, the basis for allocation of aftercare treatment is therefore not yet known and should be further studied. Funding There was no specific funding for this review.
Collapse
Affiliation(s)
- Katrina Witt
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - Katie McGill
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Local Health District, Waratah, New South Wales, Australia
| | - Bernard Leckning
- Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Nicole T.M. Hill
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | | | - Jo Robinson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - Gregory Carter
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| |
Collapse
|
3
|
Bergmann E, Peso D, Nashashibi L, Grinapol S, Meretyk I, Fruchther E, Harlev D. Association of ethnic concordance between patients and psychiatrists with the management of suicide attempts in the emergency department. Psychiatry Res 2023; 323:115167. [PMID: 36966695 DOI: 10.1016/j.psychres.2023.115167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Suicide attempt is a psychiatric emergency that can be treated with different approaches. Understanding of patient- and physician-related determinants of psychiatric interventions may help to identify sources of bias and improve clinical care. OBJECTIVE To evaluate the demographic predictors of psychiatric intervention in the emergency department (ED) following a suicide attempt. METHODS We analyzed all ED visits in Rambam Health Care Campus following suicide attempts carried out by adults between 2017-2022. Two logistic regression models were built to examine whether patient and psychiatrist's demographic variables can predict 1) the clinical decision to provide a continued psychiatric intervention and 2) the setting for the psychiatric intervention (inpatient or outpatient). RESULTS In total, 1,325 ED visits were evaluated, corresponding to 1,227 unique patients (mean age; 40.47±18.14 years, 550 men [41.51%]; 997 Jewish [75.25%] and 328 Arabs [24.75%]]), and 30 psychiatrists (9 men [30%]; 21 Jewish [70%] and 9 Arabs [30%]). Demographic variables had a limited predictive power for the decision to intervene (R²=0.0245). Yet, a significant effect of age was observed as intervention rates increased with age. In contrast, the type of intervention was strongly associated with demography (R²=0.289), with a significant interaction between patient and psychiatrist's ethnic identities. Further analysis revealed that Arab psychiatrists preferentially referred Arab patients to outpatient over inpatient treatment. CONCLUSIONS The results indicate that while demographic variables, and specifically patient and psychiatrist's ethnicity, do not affect clinical judgement for psychiatric intervention following a suicide attempt, they do play a major role in selecting treatment setting. Further studies are required to better understand the causes underlying this observation and its association with long-term outcomes. Yet, acknowledging the existence of such bias is a first step towards better culturally mindful psychiatric interventions.
Collapse
Affiliation(s)
- Eyal Bergmann
- Department of Psychiatry, Rambam Health Care Campus, Haifa, Israel
| | - Dana Peso
- Department of Psychiatry, Rambam Health Care Campus, Haifa, Israel
| | | | | | - Irit Meretyk
- Department of Psychiatry, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Eyal Fruchther
- Department of Psychiatry, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Daniel Harlev
- Department of Psychiatry, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| |
Collapse
|
4
|
When to discharge and when to voluntary or compulsory hospitalize? Factors associated with treatment decision after self-harm. Psychiatry Res 2022; 317:114810. [PMID: 36029569 DOI: 10.1016/j.psychres.2022.114810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 11/20/2022]
Abstract
Clinicians assessing suicidal patients in emergency departments (EDs) must decide whether to admit the person to a psychiatric ward with voluntary or compulsory hospitalization or to discharge him/her as an outpatient. This cross-sectional study aimed to identify independent predictors of this decision among a large sample of self-harm (SH) patients. It used data from all patients admitted to four Swiss EDs between 2016 and 2019. Socio-demographic, clinical, and suicidal process-related characteristics data were evaluated against the decision for voluntary or compulsory hospitalization using t-tests, Chi-Square tests and logistic multiple regression. 2142 episodes from 1832 unique patients were evaluated. Independent predictors of decision to hospitalize included: male gender, advanced age, hospital location, depression and personality disorders, substance use, a difficult socio-economic condition, a clear intent to die, and a serious suicide attempt. Significant variables that emerged as independent predictors of compulsory hospitalization were hospital location, not having anxiety and personality disorders, being retired, having a clear intent to die, and making a serious suicide attempt. Hospital EDs had different rates of compulsory psychiatric admission. However, the decision to admit a patient for hospitalization, either voluntary or compulsory, was mainly based on clinical factors.
Collapse
|
5
|
Knorr AC, Ammerman BA, LaFleur SA, Misra D, Dhruv MA, Karunakaran B, Strony RJ. An investigation of clinical decisionmaking: identifying important factors in treatment planning for suicidal patients in the emergency department. J Am Coll Emerg Physicians Open 2020; 1:383-391. [PMID: 33000061 PMCID: PMC7493507 DOI: 10.1002/emp2.12087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We sought to evaluate the influence of several well-documented, readily available risk factors that may influence a psychiatric consultant's decision to admit an emergency department (ED) patient reporting suicidal ideation for psychiatric hospitalization. METHODS We conducted a retrospective study of adult patients presenting to six affiliated EDs within Pennsylvania from January 2015 to June 2017. We identified 533 patients reporting current active suicidal ideation and receiving a complete psychiatric consultation. Socio-demographic characteristics, psychiatric presentation and history, and disposition were collected. Decision tree analysis was conducted with disposition as the outcome. RESULTS Four of 27 variables emerged as most influential to decisionmaking, including psychiatric consultant determination of current suicide risk, patient age, current depressive disorder diagnosis, and patient history of physical violence. Likelihood of admission versus discharge ranged from 97% to 58%, depending on the variables considered. Post hoc analysis indicated that current suicide plan, access to means, lack of social support, and suicide attempt history were significantly associated with psychiatric consultant determination of moderate-to-high suicide risk, with small-to-medium effect sizes emerging. CONCLUSIONS Only a handful of variables drive disposition decisions for ED patients reporting current active suicidal ideation, with both high and low fidelity decisions made. Patient suicide risk, determined by considering empirically supported risk factors for suicide attempt and death, contributes the greatest influence on a psychiatric consultant's decision to admit. In line with American College of Emergency Physicians (ACEP) recommendations, this study accentuates the importance of using clinical judgment and adjunct measures to determine patient disposition within this population.
Collapse
Affiliation(s)
- Anne C Knorr
- Department of Emergency Medicine Geisinger Medical Center Danville Pennsylvania USA
| | - Brooke A Ammerman
- Department of Psychology University of Notre Dame Notre Dame Indiana USA
| | - Sean A LaFleur
- Department of Emergency Medicine Geisinger Medical Center Danville Pennsylvania USA
| | - Debdipto Misra
- Geisinger System Services UDA Data Management Danville Pennsylvania USA
| | | | - Bipin Karunakaran
- Geisinger System Services UDA Data Management Danville Pennsylvania USA
| | - Robert J Strony
- Department of Emergency Medicine Geisinger Medical Center Danville Pennsylvania USA
| |
Collapse
|
6
|
Sendra-Gutiérrez JM, Esteban-Vasallo M, Domínguez-Berjón MF. Suicidal behaviour characteristics and factors associated with mortality in the hospital setting. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2018; 11:234-243. [PMID: 27137086 DOI: 10.1016/j.rpsm.2016.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/07/2016] [Accepted: 03/07/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Suicide is a major public health problem worldwide, and an approach is necessary due to its high potential for prevention. This paper examines the main characteristics of people admitted to hospitals in the Community of Madrid (Spain) with suicidal behaviour, and the factors associated with their hospital mortality. MATERIAL AND METHODS A study was conducted on patients with E950-E959 codes of suicide and self-inflicted injuries of the International Classification of Diseases, Ninth Revision, Clinical Modification, contained in any diagnostic field of the minimum basic data set at hospital discharge between 2003 and 2013. Sociodemographic, clinical and health care variables were assessed by uni- and multivariate logistic regression analysis in the evaluation of factors associated with hospital mortality. RESULTS Hospital suicidal behaviour predominates in women (58.7%) and in middle-age. Hospital mortality is 2.2% (1.6% in women and 3.2% in men), increasing with age. Mental disorders are detected 3-4 times more in secondary diagnoses. The main primary diagnosis (>74%) is poisoning with substances, with lower mortality (∼1%) than injury by hanging and jumping from high places (≥12%), which have the highest numbers. Other factors associated with increased mortality include different medical comorbidities and severity of the injury, while length of stay and mental disorders are protective factors. Type of hospital, poisoning, and Charlson index are associated differently with mortality in men and women. CONCLUSIONS Hospitalised suicidal acts show a low mortality, mainly related to comorbidities and the severity of injuries.
Collapse
Affiliation(s)
- Juan Manuel Sendra-Gutiérrez
- Servicio de Informes de Salud y Estudios, Dirección General de Salud Pública, Comunidad de Madrid, Madrid, España.
| | - María Esteban-Vasallo
- Servicio de Informes de Salud y Estudios, Dirección General de Salud Pública, Comunidad de Madrid, Madrid, España
| | - M Felicitas Domínguez-Berjón
- Servicio de Informes de Salud y Estudios, Dirección General de Salud Pública, Comunidad de Madrid, Madrid, España
| |
Collapse
|
7
|
Kroll DS, Karno J, Mullen B, Shah SB, Pallin DJ, Gitlin DF. Clinical Severity Alone Does Not Determine Disposition Decisions for Patients in the Emergency Department with Suicide Risk. PSYCHOSOMATICS 2017; 59:388-393. [PMID: 29336787 DOI: 10.1016/j.psym.2017.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/05/2017] [Accepted: 12/05/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Boarding of patients with suicide risk in emergency departments (EDs) negatively affects both patients and society. Factors other than clinical severity may frequently preclude safe outpatient dispositions among suicidal patients boarding for psychiatric admission in the ED. OBJECTIVE To determine the extent to which nonclinical factors preclude safe outpatient discharge from the ED among patients boarding for psychiatric admission based on suicide risk. METHODS A survey regarding the importance of 13 clinical and 19 nonclinical barriers to safe outpatient disposition was administered in the ED to 40 adults who were determined by psychiatrists to require inpatient level of psychiatric care due to suicide risk. A second survey regarding whether addressing the nonclinical factors would have enabled a safe outpatient disposition in each case was administered to the psychiatrists who evaluated each patient participant. RESULTS Out of 40 patient participants, 39 cited at least one nonclinical factor that could have enabled a safe outpatient disposition had it been correctable in the ED. According to the psychiatrists who made the decision to hospitalize, 10 (25%) of the patient participants could have been discharged had social support become available. CONCLUSION Both clinical and nonclinical factors affect disposition from the ED after an evaluation for suicide risk. Attention to nonclinical factors should be considered in programmatic efforts to reduce ED boarding of patients with suicide risk.
Collapse
Affiliation(s)
- David S Kroll
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA.
| | - Jennifer Karno
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA; Division of Social Work, Brigham and Women's Hospital, Boston, MA
| | - Brian Mullen
- Brigham Digital Innovation Hub, Brigham Health, Boston, MA
| | - Sejal B Shah
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Daniel J Pallin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - David F Gitlin
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| |
Collapse
|
8
|
Ferreira AD, Sponholz A, Mantovani C, Pazin-Filho A, Passos ADC, Botega NJ, Del-Ben CM. Clinical Features, Psychiatric Assessment, and Longitudinal Outcome of Suicide Attempters Admitted to a Tertiary Emergency Hospital. Arch Suicide Res 2016; 20:191-204. [PMID: 25961847 DOI: 10.1080/13811118.2015.1004491] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The objective of this study was to characterize admissions to an emergency hospital due to suicide attempts and verify outcomes in 2 years. Data were collected from medical records and were analyzed using descriptive statistics and logistic regression. The sample consisted of 412 patients (58.7% women; mean age = 32.6 years old, SD = 14.3). Self-poisoning was the most frequent method (84.0%), and they were diagnosed mainly as depressive (40.3%) and borderline personality disorders (19.1%). Previous suicide attempts and current psychiatric treatment were reported by, respectively, 32.0% and 28.4%. Fifteen patients (3.6%, 9 males) died during hospitalization. At discharge, 79.3% were referred to community-based psychiatric services. Being male (OR = 2.11; 95% CI = 1.25-3.55), using violent methods (i.e., hanging, firearms, and knives) (OR = 1.96; 95% CI = 1.02-3.75) and psychiatric treatment history (OR = 2.58; 95% CI = 1.53-4.36) were predictors for psychiatric hospitalization. Of 258 patients followed for 2 years, 10 (3.9%) died (3 suicide), and 24 (9.3%) undertook new suicide attempts. Patients with a history of psychiatric treatment had higher risks of new suicide attempts (OR = 2.46, 95% CI = 1.07-5.65). Suicide attempters admitted to emergency hospitals exhibit severe psychiatric disorders, and despite interventions, they continue to present high risks for suicide attempts and death.
Collapse
|
9
|
Minayo MCDS, Cavalcante FG. Tentativas de suicídio entre pessoas idosas: revisão de literatura (2002/2013). CIENCIA & SAUDE COLETIVA 2015; 20:1751-62. [DOI: 10.1590/1413-81232015206.10962014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 10/31/2014] [Indexed: 11/22/2022] Open
Abstract
Foi realizada revisão da literatura sobre as principais questões associadas às tentativas de suicídio em pessoas idosas. O estudo abrangeu o período de 2002 a 2013, a partir das bases Medline, Lilacs, PubMed, PsychInfo, SciELO, Biblioteca Virtual em Violência e Saúde da Bireme e Biblioteca Virtual de Saúde Pública (BVS/SP). Foram selecionadas 105 referências e analisadas 75. Os estudos se ampliaram na América do Norte, Europa e Ásia, são raros na América Latina e inexistem na África. Predominam investigações epidemiológicas. Os principais fatores predisponentes são doenças graves e degenerativas, dependência física, distúrbios e sofrimentos mentais e depressão severa. A depressão é o mais relevante fator explicativo associado a sofrimento físico crônico, perdas, abandonos, solidão e conflitos familiares. Diferenças de gênero, etnia, avanço da idade, questões sociais e traços culturais foram encontrados. O tema em pauta é da mais alta relevância para o Sistema Único de Saúde, mas não tem sido abordado no Brasil nem na teoria e nem na prática. Que esta revisão seja base para estudos empíricos que favoreçam o apoio à saúde do idoso e promova um envelhecer saudável.
Collapse
|
10
|
Jiménez-Treviño L, Saiz PA, Corcoran P, Burón P, García-Portilla MP, Chinea ER, Navio M, Fernández V, Jimenez-Arriero MA, Gracia R, Bobes J. Factors associated with hospitalization after suicide spectrum behaviors: results from a multicenter study in Spain. Arch Suicide Res 2015; 19:17-34. [PMID: 24810383 DOI: 10.1080/13811118.2013.824841] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of this study was to identify factors associated with hospital admission after suicide spectrum behaviors. Patients' characteristics, the nature of the suicidal behavior, admission rates between centers, and factors associated with admission have been examined in suicide spectrum presentations to emergency departments in 3 Spanish cities. The intent of the suicidal behavior had the greatest impact on hospitalization. Older age, living alone, self-harm method not involving drug overdose, previous history of suicide spectrum behaviors, and psychiatric diagnosis of schizophrenia, mood, or personality disorder were independently associated with being admitted. There was a 3-fold between-center difference in the rate of hospitalization. Widespread differences in the rate of hospitalization were primarily accounted for by characteristics of the individual patients and their suicidal behavior.
Collapse
|
11
|
Anderson C, Quante A. Acute interventions and referral of patients with bipolar disorder by the psychiatric consultation liaison service in a general hospital in Germany: a retrospective analysis. Prim Care Companion CNS Disord 2014; 16:13m01602. [PMID: 25133062 DOI: 10.4088/pcc.13m01602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To investigate the population of bipolar patients in a general hospital in Germany who required treatment by a consultant psychiatrist. METHOD A retrospective analysis was conducted of the clinical records of 47 patients diagnosed with bipolar disorder (DSM-IV-TR criteria) who were treated by a consultant psychiatrist between 2009 and 2012 in one of the general hospitals of Charité Berlin, Campus Benjamin Franklin, Berlin, Germany. We investigated the sections of the hospital that requested psychiatric consultations for bipolar patients, the status of these patients, and their primary cause of treatment, as well as the intervention (including pharmacotherapy) recommended by the consultant psychiatrist. RESULTS For more than half of the patients, their psychiatric illness was either directly or indirectly the reason they presented to the hospital. The remaining bipolar patients were treated for various somatic illnesses unrelated to their bipolar disorder throughout the hospital, with a relative overrepresentation of patients in the neurology department. More than half of the patients were referred to a psychiatric hospital by the consultant psychiatrist. Benzodiazepines were the most commonly administered drugs for acute pharmacologic intervention. CONCLUSIONS Psychiatric consultations are not frequently requested for bipolar patients compared to those with other psychiatric disorders. However, more than half of the bipolar patients needed further psychiatric treatment in a psychiatric hospital. This finding emphasizes the importance of psychiatric consultations in a general hospital for bipolar patients. The administration of benzodiazepines as an acute treatment seems to be the standard pharmacologic procedure, not a specific pharmacotherapy like mood stabilizers.
Collapse
Affiliation(s)
- Christina Anderson
- Department of Psychiatry and Psychotherapy, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Arnim Quante
- Department of Psychiatry and Psychotherapy, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
| |
Collapse
|
12
|
Sinclair SJ, Smith M, Chung WJ, Liebman R, Stein MB, Antonius D, Siefert CJ, Haggerty G, Blais MA. Extending the validity of the Personality Assessment Inventory's (PAI) Level of Care Index (LOCI) in multiple psychiatric settings. J Pers Assess 2014; 97:145-52. [PMID: 25101817 DOI: 10.1080/00223891.2014.941441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to extend the validity and clinical application of the Level of Care Index (LOCI) from the Personality Assessment Inventory (PAI) in 2 independent psychiatric samples. In Study 1 (N = 201), the LOCI effectively differentiated level of care (inpatients from outpatients), and was also meaningfully associated with risk factors for psychiatric admission (e.g., suicidal ideation, self-harming behavior, previous psychiatric admission, etc.), even after controlling for other demographic variables (range of Cohen's ds = 0.57-1.00). Likewise, the LOCI also incremented other risk indicators (suicide and violence history) and relevant PAI indexes (i.e., Mean Clinical Elevation, and Suicide and Violence Potential) in predicting level of care, and explained an additional 6% to 12% of variance in the target variable. Diagnostic efficiency analyses indicated LOCI scores in the range of 15 to 18 optimize positive and negative predictive power, and classification rate. In Study 2 (N = 96), the LOCI was found to be significantly higher in those with a recent psychiatric admission within the past 6 months (d = 0.64), as compared to those without an admission. Similarly, those who were admitted for suicide risk had significantly higher mean LOCI scores as compared to those who did not (d = 0.70). The clinical implications of these findings and potential application of the LOCI are discussed.
Collapse
Affiliation(s)
- Samuel Justin Sinclair
- a Psychological Evaluation and Research Laboratory (PEaRL), Massachusetts General Hospital and Harvard Medical School
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
OBJECTIVE AND METHOD To consider the possibility that adverse aspects of psychiatric hospitalisation may precipitate suicide contributing significantly to the increased rate of suicide among inpatients, given little has been published about this. RESULTS AND CONCLUSIONS It is likely that psychiatric hospitalisation itself contributes to some inpatient suicides. This has significant implications for the delivery of inpatient psychiatric care.
Collapse
Affiliation(s)
- Matthew Large
- Mental Health Services, The Prince of Wales Hospital, Randwick, NSW, and; School of Psychiatry, University of New South Wales, Kensington, NSW, Australia
| | | | | | | | | |
Collapse
|
14
|
Parra Uribe I, Blasco-Fontecilla H, García-Parés G, Giró Batalla M, Llorens Capdevila M, Cebrià Meca A, de Leon-Martinez V, Pérez-Solà V, Palao Vidal DJ. Attempted and completed suicide: not what we expected? J Affect Disord 2013; 150:840-6. [PMID: 23623420 DOI: 10.1016/j.jad.2013.03.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 03/11/2013] [Accepted: 03/13/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Suicide attempters and suicide completers are two overlapping but distinct suicide populations. This study aims to present a more accurate characterization by comparing populations of suicide attempters and completers from the same geographical area. METHODS Samples and procedure: All cases of attempted suicide treated at the emergency room of the Corporacio Sanitària i Universitària Tauli Parc de Sabadell in 2008 (n=312) were compared with all completed suicides recorded in the same geographical area from 2008 to 2011 (n=86). Hospital and primary care records were reviewed for sociodemographic and clinical variables. STATISTICAL ANALYSIS Chi-square, ANOVA, and Mann-Whitney U tests were used to identify characteristics related to suicide completion. RESULTS Compared to suicide attempters, suicide completers were more likely to be male (73.3% vs. 37.8%; p<0.001), pensioners (73.7% vs. 23.4%; p<0.001), and people living alone (31.8% vs. 11.4%; p=0.006). Suicide completers more frequently presented somatic problems (71.7 vs. 15.7; p<0.001), Major Depressive Disorder (54.7% vs. 27.9%; p<0.001), and made use of more lethal methods (74.1 vs. 1.9; p<0.001). Suicide completers were more likely to have been followed by a primary care provider (50.0% vs. 16.0%; p<0.001). 92.3% of the suicides committed were completed during the first or second attempt. LIMITATIONS Suicide completers were not evaluated using the psychological autopsy method. CONCLUSIONS Despite presenting a profile of greater social and clinical severity, suicide completers are less likely to be followed by Mental Health Services than suicide attempters. Current prevention programs should be tailored to the specific profile of suicide completers.
Collapse
Affiliation(s)
- I Parra Uribe
- Department of Mental Health, Corporacio Sanitària Parc Tauli de Sabadell (Barcelona), Institut Universitari Parc Tauli-Universitat Autònoma de Barcelona, Campus d'Excellència Internacional, 08193 Bellaterra, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Marcus SC, Bridge JA, Olfson M. Payment source and emergency management of deliberate self-harm. Am J Public Health 2012; 102:1145-53. [PMID: 22515853 PMCID: PMC3483957 DOI: 10.2105/ajph.2011.300598] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated whether health insurance type (private vs Medicaid) influences the delivery of acute mental health care to patients with deliberate self-harm. METHODS Using National Medicaid Analytic Extract Files (2006) and MarketScan Research Databases (2005-2007), we analyzed claims focusing on emergency episodes of deliberate self-harm of Medicaid- (n=8,228) and privately (n=2,352) insured adults. We analyzed emergency department mental health assessments and outpatient mental health visits in the 30 days following the emergency visit for discharged patients. RESULTS Medicaid-insured patients were more likely to be discharged (62.7%), and among discharged patients they were less likely to receive a mental health assessment in the emergency department (47.8%) and more likely to receive follow-up outpatient mental health care (52.9%) than were privately insured patients (46.9%, 57.3%, and 41.2%, respectively). CONCLUSIONS Acute emergency management of deliberate self-harm is less intensive for Medicaid- than for privately insured patients, although discharged Medicaid-insured patients are more likely to receive follow-up care. Programmatic reforms are needed to improve access to emergency mental health services, especially in hospitals that serve substantial numbers of Medicaid-insured patients.
Collapse
Affiliation(s)
- Steven C Marcus
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, School of Social Policy and Practice of the University of Pennsylvania, Philadelphia, USA
| | | | | |
Collapse
|