Suicidal behaviour: emergency department attendance for suicidal recurrence and other psychiatric or medical reasons in the 6 months following the index episode

Abstract

Introduction. The prevention of a complex phenomenon, such as suicide, requires an interdisciplinary approach that provides a comprehensive response to the care needs of people with suicidal behavior (SB). The aim of this study is to investigate the clinical and healthcare features of people presenting thoughts and/or attempts of suicide to define risk factors for recurrence.

Methods. A cohort study was carried out with a 6-month follow-up. The cohort consisted of persons admitted to the emergency department of the Hospital Universitario Marqués de Valdecilla (Santander) presenting thoughts and/or attempts of suicide, throughout a 4-month recruitment period: 1-March to 30-June 2015. Sociodemographic and clinical variables were collected in the index episode and visits to the emergency department during the following 6 months.

Results. 143 patients were assessed by SB, and it was possible to collect information on recurrence in 110 (average age of 43.31; range 16-84; 65% women). Twenty-one percent presented recurrence of SB: 10% attempted, 6% thoughts, and 5% both; 1 (0.7%) committed suicide; most frequently with age 30-65 years and with a history of mental illness. During follow-up, 60% consulted repeatedly in the emergency department not only for SB but also for other psychiatric or medical reasons, independently of follow-up in the mental health service.

Conclusions. Recurrence of SB is common despite being followed up in the mental health service. In addition, people with SB frequently and repeatedly consult the emergency department for other psychiatric and medical reasons, suggesting that the conventional approach to comorbidity with SB is insufficient. Further studies are needed to define risk profiles and design specific interdisciplinary strategies for SB management and suicide prevention, avoiding fragmentation. This will contribute more efficiently to early identification, appropriate management and prevention of suicide recurrences and deaths.