When to discharge and when to voluntary or compulsory hospitalize? Factors associated with treatment decision after self-harm

Laurent Michaud; Sébastien Berva; Louise Ostertag; Alessandra Costanza; Bénédicte Van der Vaeren; Yves Dorogi; Stéphane Saillant; Philippe Golay; Stéphane Morandi

doi:10.1016/j.psychres.2022.114810

When to discharge and when to voluntary or compulsory hospitalize? Factors associated with treatment decision after self-harm

Psychiatry Res. 2022 Nov:317:114810. doi: 10.1016/j.psychres.2022.114810. Epub 2022 Aug 21.

Authors

Laurent Michaud¹, Sébastien Berva², Louise Ostertag², Alessandra Costanza³, Bénédicte Van der Vaeren⁴, Yves Dorogi², Stéphane Saillant⁵, Philippe Golay⁶, Stéphane Morandi⁷

Affiliations

¹ Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Avenue de Beaumont 23, Lausanne 1011, Switzerland. Electronic address: laurent.michaud@chuv.ch.
² Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Avenue de Beaumont 23, Lausanne 1011, Switzerland.
³ Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland; Departement of Psychiatry, Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland.
⁴ Pole of Psychiatry and Psychotherapy, Liaison Psychiatry Service, Hospital Centre of Valais Romand, Switzerland.
⁵ Centre for Psychiatric Emergencies and Liaison Psychiatry, Department of General and Liaison Psychiatry, Neuchâtel Psychiatry Centre, Switzerland. University of Lausanne, Lausanne, Switzerland.
⁶ Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Switzerland.
⁷ Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; General Directorate for Health of Canton of Vaud, Department of Health and Social Action (DSAS), Cantonal Medical Office, Avenue des Casernes 2, Lausanne 1014, Switzerland.

PMID: 36029569
DOI: 10.1016/j.psychres.2022.114810

Abstract

Clinicians assessing suicidal patients in emergency departments (EDs) must decide whether to admit the person to a psychiatric ward with voluntary or compulsory hospitalization or to discharge him/her as an outpatient. This cross-sectional study aimed to identify independent predictors of this decision among a large sample of self-harm (SH) patients. It used data from all patients admitted to four Swiss EDs between 2016 and 2019. Socio-demographic, clinical, and suicidal process-related characteristics data were evaluated against the decision for voluntary or compulsory hospitalization using t-tests, Chi-Square tests and logistic multiple regression. 2142 episodes from 1832 unique patients were evaluated. Independent predictors of decision to hospitalize included: male gender, advanced age, hospital location, depression and personality disorders, substance use, a difficult socio-economic condition, a clear intent to die, and a serious suicide attempt. Significant variables that emerged as independent predictors of compulsory hospitalization were hospital location, not having anxiety and personality disorders, being retired, having a clear intent to die, and making a serious suicide attempt. Hospital EDs had different rates of compulsory psychiatric admission. However, the decision to admit a patient for hospitalization, either voluntary or compulsory, was mainly based on clinical factors.

Keywords: Hospitalization; Patient admission; Risk management; Self-harm; Suicide attempt.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Female
Hospitalization
Humans
Male
Patient Discharge*
Self-Injurious Behavior* / epidemiology
Self-Injurious Behavior* / psychology
Self-Injurious Behavior* / therapy
Suicidal Ideation
Suicide, Attempted / psychology