title: Suicidality and hospitalization as cause and outcome of pediatric psychiatric emergency room visits.
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.
authors.affiliation: Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Grudnikoff
authors.forename: Erin Callahan
authors.initials: EC
authors.lastname: Soto
authors.forename: Anne
authors.initials: A
authors.lastname: Frederickson
authors.forename: Michael L
authors.initials: ML
authors.lastname: Birnbaum
authors.forename: Ema
authors.initials: E
authors.lastname: Saito
authors.forename: Robert
authors.initials: R
authors.lastname: Dicker
authors.forename: John M
authors.initials: JM
authors.lastname: Kane
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009519:New York City / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000706:statistics & numerical data*