Characteristics of psychiatric emergencies and the choice of intervention strategies.

The aim of this study was to describe the sociodemographic, contextual and clinical characteristics of a consecutive sample of 3611 psychiatric emergency visits to a Swiss university general hospital, and to investigate their associations with different intervention strategies. All consultations were documented by a questionnaire covering sociodemographic and diagnostic data as well as information about the consultation and the disposition decision. In a total of 1093 cases (30.3%) no further emergency intervention was required, in 1287 cases (35.6%) patients were offered out-patient crisis intervention, and in 1231 cases (34.1%) patients were hospitalized. Social integration and the presence of an easily recognizable precipitating stressor were associated with referral to out-patient crisis intervention. In logistic regression analyses, referral by the police or by health professionals (in contrast to self-referral or referral by relatives), current diagnosis of a psychotic disorder, and previous hospitalizations were the most powerful predictors of hospitalization. The presence of a precipitating stressor related to the patient's social network decreased the likelihood of hospitalization. The findings indicate a need for facilities offering brief admission, allowing for extended emergency assessments.