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01-07-2015 | Original Contribution

Suicidality and hospitalization as cause and outcome of pediatric psychiatric emergency room visits

Authors: Eugene Grudnikoff, Erin Callahan Soto, Anne Frederickson, Michael L. Birnbaum, Ema Saito, Robert Dicker, John M. Kane, Christoph U. Correll

Published in: European Child & Adolescent Psychiatry | Issue 7/2015

Abstract

The aim of this study was to identify predictors of suicidality in youth presenting to a pediatric psychiatric emergency room service (PPERS). To this end, we conducted a retrospective cohort study of youth aged <18 years consecutively assessed by a PPERS 01.01.2002–12.31.2002, using a 12-page semi-structured institutional evaluation form and the Columbia Classification Algorithm for Suicide Assessment. Multivariate regression analyses were conducted to identify correlates of suicidal thoughts and attempts/preparation and their relationship to outpatient/inpatient disposition. Of 1,062 youth, 265 (25.0 %) presented with suicidal ideation (16.2 %) or attempt/preparation (8.8 %). Suicidal ideation was associated with female sex, depression, adjustment disorder, absent referral by family/friend/self, school referral, precipitant of peer conflict, and no antipsychotic treatment (p < 0.0001). Suicidal attempt/preparation was associated with female sex, depression, lower GAF score, past suicide attempt, precipitant of peer conflict, and no stimulant treatment (p < 0.0001). Compared to suicidal attempt/preparation, suicidal ideation was associated with school referral, and higher GAF score (p < 0.0001). Of the 265 patients with suicidality, 58.5 % were discharged home (ideation = 72.1 % vs. attempt/preparation = 33.7 %, p < 0.0001). In patients with suicidal ideation, outpatient disposition was associated with higher GAF score, school referral, and adjustment disorder (p < 0.0001). In patients with suicidal attempt/preparation, outpatient disposition was associated with higher GAF score, lower acuity rating, and school referral (p < 0.0001). Suicidality is common among PPERS evaluations. Higher GAF score and school referral distinguished suicidal ideation from suicidal attempt/preparation and was associated with outpatient disposition in both presentations. Increased education of referral sources and establishment of different non-PPERS evaluation systems may improve identification of non-emergent suicidal presentations and encourage more appropriate outpatient referrals.

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Title: Suicidality and hospitalization as cause and outcome of pediatric psychiatric emergency room visits
Authors: Eugene Grudnikoff
Erin Callahan Soto
Anne Frederickson
Michael L. Birnbaum
Ema Saito
Robert Dicker
John M. Kane
Christoph U. Correll
Publication date: 01-07-2015
Publisher: Springer Berlin Heidelberg
Published in: European Child & Adolescent Psychiatry / Issue 7/2015
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI: https://doi.org/10.1007/s00787-014-0624-x

At a glance: The STEP trials

Springer Medicine

Suicidality and hospitalization as cause and outcome of pediatric psychiatric emergency room visits

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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