title: Emergency department admission and mortality rate for suicidal behavior. A follow-up study on attempted suicides referred to the ED between January 2004 and December 2010.
abstract: BACKGROUND
  The international literature reports that for every completed suicide there are between 8 and 22 visits to an Emergency Department (ED) for attempted suicide/suicidal behavior.
  
  
  OBJECTIVE
  To describe the characteristics of admission to emergency departments (EDs) for suicide-related presenting complaints in the metropolitan area of Bologna; to estimate the risk for all-cause mortality and for suicide; to identify the profiles of subjects most at risk.
  
  
  METHODS
  Follow-up of patients admitted to the EDs of the metropolitan area of Bologna between January 2004 and December 2010 for attempted suicide. A Cox model was used to evaluate the association between sociodemographic variables and the general mortality risk.
  
  
  RESULTS
  We identified 505 cases of attempted suicide, which were more frequent for female subjects, over the weekend, and at night (8:00 p.m./8:00 a.m.). The most used suicide methods were psychotropic drugs, sharp or blunt objects, and jumping from high places. In this cohort, 3.6% of subjects completed suicide (4.5% of males vs. 2.9% of females), 2.3% within 1 year of the start of follow-up. The most common causes of death were drug use and hanging. In the multivariate analysis, those who used illicit drugs 24 hr prior to admission to the ED (hazard ratio [HR] = 3.46, 95% CI = 1.23-9.73) and patients who refused the treatment (HR = 6.74, 95% CI = 1.86-24.40) showed an increased mortality risk for suicide.
  
  
  CONCLUSIONS
  Deliberate self-harm patients presenting to the ED who refuse treatment represent a specific target group for setting up dedicated prevention schemes.
authors.affiliation: <location>Department of Mental Health and Substance Abuse, Local Health Trust of Bologna, Italy</location>
authors.forename: Raimondo Maria
authors.initials: RM
authors.lastname: Pavarin
authors.affiliation: <location>Department of Mental Health and Substance Abuse, Local Health Trust of Bologna, Italy</location>
authors.forename: Angelo
authors.initials: A
authors.lastname: Fioritti
authors.affiliation: <location>School of Psychiatry, University of Perugia, Italy</location>
authors.forename: Francesca
authors.initials: F
authors.lastname: Fontana
authors.affiliation: <location>Department of Mental Health and Substance Abuse, Local Health Trust of Bologna, Italy</location>
authors.forename: Silvia
authors.initials: S
authors.lastname: Marani
authors.affiliation: <location>Department of Psychosis, King's College London, UK</location>
authors.forename: Alessandra
authors.initials: A
authors.lastname: Paparelli
authors.affiliation: <location>Department of Mental Health and Substance Abuse, Local Health Trust of Bologna, Italy</location>
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Boncompagni
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013405:Suicide / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000706:statistics & numerical data*
keywords: follow-up; mortality; suicide attempts