Addiction and suicidal behavior in acute psychiatric inpatients.
OBJECTIVE
This study aims to evaluate the relationship of alcohol/drug use and effect severities to the degree of suicidality in acutely admitted psychiatric patients. Both degree of substance dependency and degree of substance-induced syndrome were analyzed. In addition, length of stay, involuntary status, and against medical advice discharge status were determined as they related to these variables.


METHODS
Structured clinical admissions and discharge ratings were gathered from 10,667 consecutive, single-case individual records, from an urban acute care county psychiatric hospital.


RESULTS
Data indicate that of the most severely suicidal group, 56% had substance abuse or dependence, 40% were rated as having half or more of their admission syndrome substance induced, and most had nonpsychotic diagnoses. There was an inverse relationship between degree of substance problem and length of stay. Although these patients more commonly left against medical advice, and were readmitted more frequently, they were less likely to be involuntarily committed.


CONCLUSIONS
A large, potentially lethal, and highly expensive subgroup of patients has been characterized, which might be called the "New Revolving Door acute psychiatric inpatient." This group, which uses the most expensive level of care in the mental health system but is substantially addiction related, poses special challenges for inpatient psychiatric units, addiction treatment providers, and health care planners.
Ries
Richard K
RK
University of Washington, Seattle, WA, USA. rries@u.washington.edu
Yuodelis-Flores
Christine
C
Roy-Byrne
Peter P
PP
Nilssen
Odd
O
Russo
Joan
J
D000328:Adult; D003134:Commitment of Persons with Psychiatric Disorders / Q000706:statistics & numerical data; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000523:psychology*; D013405:Suicide / Q000523:psychology*; D016312:Treatment Refusal / Q000706:statistics & numerical data