Goldberg Joseph F, Ernst Carrie L, Bird Suzanne
Affective Disorders Program, Silver Hill Hospital, 208 Valley Rd., New Canaan, CT 06840, USA.
Psychiatr Serv. 2007 Apr;58(4):561-5. doi: 10.1176/ps.2007.58.4.561.
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.
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.
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.
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.
自杀观念常常促使患者前往精神科急诊就诊，对于影响临床医生决定将有自杀观念的患者收住院或予以出院的因素，我们还需要了解更多。
作者回顾了257例有自杀观念并前往精神科急诊就诊患者的记录。通过向后逐步二元逻辑回归分析来研究住院治疗的人口统计学和临床相关因素。
70%有自杀观念的患者被收住院，且住院与精神病、自杀未遂史及自杀计划显著相关。在控制了潜在混杂因素后，这些变量正确分类了80%的住院治疗决定。
精神病、既往自杀未遂及存在自杀计划有力地预测了在精神科急诊就诊的有自杀观念患者的住院治疗决定。诊断、药物治疗、是否有精神科医生及保险类型与住院治疗决定无关，这表明当精神病和自杀计划与自杀观念并存时，精神科急诊工作人员认为除了收住院几乎没有其他选择。
