Approaches to managing medically serious suicide attempts referred to consultation-liaison psychiatry
R. Sánchez-González, E. Monteagudo-Gimeno, E. Marí-Cardona, L. Pintor-PérezIntroduction
The term medically serious suicide attempts (MSSA) is used to group those attempts that would have been fatal if not for medical intervention. Although studying MSSA is crucial for understanding the nature of suicide and developing prevention strategies, little is known about the underlying risk factors and demographic characteristics associated with it.
Objectives
To describe and evaluate the characteristics of MSSA within the context of a general hospital consultation-liaison psychiatry (CLP) service.
Methods
Longitudinal observational case-control design, including adult inpatients consecutively referred to the consultation-liaison psychiatry (CLP) service at the University Clinical Hospital of Barcelona from 2007 to 2014. Cases were selected according to the criteria established by Beautrais in prior research for defining MSSA. The control group consisted of patients referred to the CLP service from medical or surgical units for reasons other than MSSA. All patients underwent assessment through a structured psychiatric interview based on the DSM-IV (SCID-CV). Data were collected prospectively via a computerized clinical database and included the following variables:
Sociodemographic factors: age, gender, and physical disability.
Psychiatric morbidity classified according to DSM-IV-TR categories, based on the SCID-CV assessment, along with history of psychiatric disorders and prior suicide attempts.
Psychosocial stressors and recent exposure to stressful life events.
Variables related to the current hospitalization and CLP intervention.
Results
The study comprised 223 consultations involving patients with MSSA (4.1%) and 5,205 consultations for other reasons (95.9%). The sociodemographic and clinical characteristics of both subgroups are illustrated in the accompanying figure. Patients presenting with MSSA were significantly younger than those in the control group (47.3 vs. 55.3 years; p < 0.001). Additionally, they exhibited a higher prevalence of psychosocial stressors (54.3% vs. 24%; p < 0.001), prior suicide attempts (54.3% vs. 3.1%; p < 0.001), and psychiatric disorders (78.9% vs. 54.5%; p < 0.001), predominantly mood and personality disorders. Intensive care was required in 10% of MSSA cases, compared to only 0.9% in the control group (p < 0.001). During hospitalization, the majority of MSSA patients (77.1%) necessitated extensive follow-up within the CLP service, involving two or more visits. The mean length of hospital stay was significantly shorter for MSSA patients compared to controls (18.4 vs. 25.3 days; p < 0.003). Nevertheless, 24.3% of MSSA patients were eventually transferred to psychiatric inpatient units following discharge from medical or surgical wards.
Image 1: Long description.