Correlates and outcomes of different suicidal ideation presentations in the emergency department: a longitudinal study

Abstract

OBJECTIVES: This study examined individuals who were assessed for suicidal ideation in the emergency department in order to determine whether ideation subtypes (active desire for death versus ambivalence about living) differentially predict risk for future suicide attempt. METHOD: Participants were individuals presenting to psychiatric services in the emergency department between January 2009 and December 2013 at two hospitals in Canada. Ambivalent suicidal ideation, active suicidal ideation, and presentations that included both subtypes of ideation were examined as predictors of suicide attempt within 6 months. RESULTS: Of the 8413 individuals presenting with to the emergency room 333 presented with a repeat attempt. Ambivalent suicide ideation, and active ambivalent ideation were predictive of suicide attempts in 6 months [Adjusted odds ratio (AOR)=1.94, 95% confidence interval (CI) 1.11-3.39; AOR (both) = 4.72, 95% (CI) 3.0.9 to 7.21, respectively). Active ideation; however, was not predictive of a suicide attempt within 6 months. (AOR)=1.54, 95% confidence interval (CI) 0.651-3.65. CONCLUSION: Psychiatric presentations to the emergency department often include suicidal ideation. Differentiating between active and passive suicidal ideation does not help in predicting outcomes, and the terminology may be downplaying the severity of presentations that include passive ideation. Mental health professionals should view presentations involving any form of suicidal ideation as a serious risk for future attempts and consider appropriate resources, support and treatment.