Original Research Attempted Suicide: Factors Leading to Hospitalization

anaging suicidal crises and assessing the suicide risk of patients admitted to the emergency room (ER) after at-tempted suicide are common but challenging tasks requiring profound clinical experience. Though proposed long ago, generally accepted guidelines for dispositional decisions in psychiatric emergency services have yet to be developed (1,2). Attempted suicide is the strongest predictor for suicide or parasuicide. In the year following attempted suicide, the aver-age rate of repeated nonfatal attempts was reported to be 17% (3). In follow-up studies conducted 5 to 9 years after attempted suicide, 3 % to 13 % of patients eventually commit-ted suicide (4–8). The risk for suicide among self-harm 736 Can J Psychiatry, Vol 49, No 11, November 2004 Objective: This study analyzes how sociodemographic and clinical characteristics influence the treatment decision for patients referred to a university hospital emergency room (ER) owing to attempted suicide. Method: Using a cross-sectional design, we monitored all patients admitted to a university hospital ER after attempting suicide, over a 3-year period (n = 404). Treatment decisions were categorized into 3 groups: inpatient treatment, outpatient treatment, and no further treatment. Results: Older patients were more likely to be hospitalized, while women and patients with regular occupational activity were more likely to receive outpatient treatment. In logistic regression analysis, attempted suicide using aggressive methods, history of psychiatric inpatient treatment, and psychotic disorders were associated with inpatient treatment. Adjustment and neurotic disorders were related to outpatient treatment. Conclusions: The decision to hospitalize can be satisfactorily predicted by means of sociodemographic and clinical characteristics, while the number of patients assigned to outpatient treatment is underestimated. A triage that relies only on sociodemographic and clinical data as well as risk factors could result in too frequent admissions of patients after attempted suicide