Timothy Schmutte1, Mark Olfson2, Ming Xie3, Steven C Marcus4. 1. Yale University, Department of Psychiatry, Program for Recovery and Community Health, New Haven, CT, USA. Electronic address: timothy.schmutte@yale.edu. 2. Columbia University, Department of Psychiatry and the New York State Psychiatric Institute, New York, NY, USA. 3. University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA. 4. University of Pennsylvania, School of Social Policy & Practice, Philadelphia, PA, USA.
Abstract
OBJECTIVE: To examine predictors of hospitalization among older adults at high risk for suicide treated in emergency departments (EDs). METHODS: This retrospective cohort analysis used national 2015 Medicare claims for adults ≥65 years with ED visits for suicide ideation or deliberate self-harm (N = 50,472) merged with data from the Area Health Resource File. Rates and adjusted risk ratios (ARR) of hospital admission were assessed. RESULTS: A majority of ED episodes resulted in hospital admission (81.9%) with most being admitted to a psychiatric unit (62.8%). Visits for self-harm with suicide ideation were most likely to result in hospitalization (94.7%) compared to suicide ideation alone (84.0%) or self-harm alone (73.1%). Current diagnosis of depression, bipolar, anxiety, cognitive, and personality disorder were associated with hospitalization. Co-occurring mental and substance use disorders were the most predictive mental health condition of admission. Overall, severity of current medical comorbidity was the strongest predictor of hospital admission. CONCLUSIONS: Most older adults treated in EDs for suicide ideation or self-harm are hospitalized. Medical morbidity plays a more prominent role than other patient factors in admission status.
OBJECTIVE: To examine predictors of hospitalization among older adults at high risk for suicide treated in emergency departments (EDs). METHODS: This retrospective cohort analysis used national 2015 Medicare claims for adults ≥65 years with ED visits for suicide ideation or deliberate self-harm (N = 50,472) merged with data from the Area Health Resource File. Rates and adjusted risk ratios (ARR) of hospital admission were assessed. RESULTS: A majority of ED episodes resulted in hospital admission (81.9%) with most being admitted to a psychiatric unit (62.8%). Visits for self-harm with suicide ideation were most likely to result in hospitalization (94.7%) compared to suicide ideation alone (84.0%) or self-harm alone (73.1%). Current diagnosis of depression, bipolar, anxiety, cognitive, and personality disorder were associated with hospitalization. Co-occurring mental and substance use disorders were the most predictive mental health condition of admission. Overall, severity of current medical comorbidity was the strongest predictor of hospital admission. CONCLUSIONS: Most older adults treated in EDs for suicide ideation or self-harm are hospitalized. Medical morbidity plays a more prominent role than other patient factors in admission status.
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