Predicting hospitalization versus discharge of suicidal patients presenting to a psychiatric emergency service.

OBJECTIVE

Suicidal ideation frequently prompts visits to psychiatric emergency departments, and more information is needed about factors that mediate clinicians' decisions to hospitalize or discharge patients with suicidal ideation.

METHODS

The authors reviewed records for 257 patients presenting with suicidal ideation to a psychiatric emergency service. Demographic and clinical correlates of hospitalization were examined by backward stepwise binary logistic regression.

RESULTS

Hospitalization occurred for 70% of suicidal persons and was significantly associated with psychosis, a history of attempted suicide, and a suicidal plan. With potential confounding factors controlled, these variables correctly classified 80% of hospitalization decisions.

CONCLUSIONS

Psychosis, past suicide attempts, and the presence of a suicide plan robustly predicted the decision to hospitalize suicidal persons seen in psychiatric emergency services. Diagnosis, pharmacotherapy, having a psychiatrist, and insurance subtype were unrelated to hospitalization decisions, suggesting that psychiatric emergency department staff perceive few alternatives to hospitalization when psychosis and suicide plans accompany suicidal ideation.