POSTED: December 23rd, 2019
POSTED IN: EPIC - The Official Newsletter of MOCEP, November/December 2019,
Patients commonly present to the emergency department with an array of psychiatric complaints, including suicidal ideation. While we can lament in the lack of utility of psychiatric ‘screening labs’, we know it is important to get this population prompt psychiatric care. What we don’t know is what occurs with these patients long term. This is particularly important as many will present multiple times to the emergency department, and it’s difficult to know how concerned we should be when they represent.
A new study in JAMA Network Open studied this in California. In this study, the authors obtained data from patients presenting to EDs from January 2009 to December 2011 that were older than 10. Using ICD-9 codes patients were divided into one of three groups: those presenting with self-harm, those presenting with suicidal ideation, and a random sample of 5% of patients included as a reference population. These patients were then matched to the Office of Statewide Health Planning and Development to determine how many died over the next year and their manner of death.
The study included 648,646 patients with a mean age of 43.8 years. 83,507 patients presented following self-harm of which 59% were women; 67, 379 patients presented with suicidal ideation of which 51% were women; and there were 497,760 reference patients. They found that patients presenting with deliberate self-harm had a suicide rate 56.8 times higher over the next year compared to demographically similar individuals. The suicide rate was 31.4 times higher for those presenting with suicidal ideation. In these populations even the risk of death from unintentional injury was elevated, likely due to a high risk of overdose. Overdoses were responsible for 72% of all unintentional deaths in the self-harm cohort and 61% of those originally presenting with suicidal ideation.
To read more about the study you can go to https://www.nih.gov/news-events/news-releases/emergency-department-study-reveals-patterns-patients-increased-risk-suicide or for the full study https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2757488.