Does categorization of suicide risk affect patient outcomes? A study of emergency department presentations

Abstract

OBJECTIVE: This study examined psychiatric emergency room presentations that were assessed for suicide risk. These individuals were assessed to determine whether active suicide ideation differentially predicted future suicide attempts compared to ambivalence about living (passive suicide ideation), or a combination of both subtypes. METHOD: Participants were individuals presenting to psychiatric services in the emergency department between January 2009 and December 2014 (11886 presentations) at two hospitals in Manitoba, Canada. Patients were classified into four categories: Ambivalence about living, Active suicide ideation, Combined suicide ideation and No suicide ideation. RESULTS: Of the 5077 individuals presenting to the emergency room during the study, 155 (3.0%) presented with a suicide attempt in 6 months. Ambivalence about living was predictive of suicide attempts in 6 months [Adjusted odds ratio (AOR)= 3.66 (95% confidence interval (CI): 2.35-5.83, p <. 001)] as were the Combined presentations [AOR)= 6.40 (95% CI: 4.42-9.33, p <. 001)] whereas Active suicide ideation did not predict risk for future suicide attempt [AOR=2.12 (95% CI: 0.99 - 4.51), p >.05]. CONCLUSION: Suicide ideation is a common presentation to emergency departments. Treatment decisions are often made by categorizing presentations according to level of risk, with active suicide ideation often classified as being higher risk. However, the results of this study demonstrate that the current terminology may be downplaying the severity of presentations that include ambivalent suicide 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.