Elsevier

General Hospital Psychiatry

Volume 28, Issue 4, July–August 2006, Pages 323-329
General Hospital Psychiatry

Emergency Psychiatry in the General Hospital
The emergency room is the interface between community and health care institution. Whether through outreach or in-hospital service, the psychiatrist in the general hospital must have specialized skill and knowledge to attend the increased numbers of mentally ill, substance abusers, homeless individuals, and those with greater acuity and comorbidity than previously known. This Special Section will address those overlapping aspects of psychiatric, medicine, neurology, psychopharmacology, and psychology of essential interest to the psychiatrist who provides emergency consultation and treatment to the general hospital population.
Routine use of the Beck Scale for Suicide Ideation in a psychiatric emergency department

https://doi.org/10.1016/j.genhosppsych.2006.04.003Get rights and content

Abstract

Background

U.S. suicide rates are estimated to be 11 per 100,000 people, and improved screening in emergency departments may reduce suicide rates.

Method

This study examined the relationship between clinician rating of suicide ideation and Beck Scale for Suicide Ideation (BSI) scores when clinicians had access to the BSI results and whether BSI scores and/or clinician ratings of suicidality are associated with patient disposition from the psychiatric emergency department.

Results

Of 735 patients, 665 (90%) had documentation of suicide ideation in the chart; 246 (37%) were rated as suicidal; 487 (66%) patients completed the BSI forms; 300 patients (62%) scored positive on the BSI. Logistic regression analysis for BSI scores and clinician ratings of suicidality showed similar results, except clinicians were more likely to rate males as suicidal, while BSI scores did not vary according to sex. Hospitalization occurred more often for patients with mood disorder who had positive BSI scores, while hospitalization occurred more often for patients with a diagnosis of bipolar disorder or schizophrenia who were rated by clinicians as suicidal.

Conclusions

There were important demographic and diagnostic differences revealed by logistic regression analysis of BSI scores and clinician-rated suicidality, and these differences may be associated with disposition for patients presenting with suicide ideation.

Introduction

Suicide rates in the United States are estimated to be 11 per 100,000 people [1], [2]. Many patients have contact with health care professionals prior to committing suicide [3], [4], [5], [6]. Therefore, clinicians who see patients in the emergency room would benefit from the development of improved methods for suicide assessment.

One strategy to improve suicide assessment is by the use of psychometric rating scales [7], [8]. However, psychiatric emergency rooms are generally too busy to dedicate a clinician to the completion of myriad ratings scales. The development of a self-report version of the Beck Scale for Suicide Ideation (BSI) may be a screening tool of use by psychiatric emergency clinicians to enhance the detection of suicidality in patients [8], [9]. However, there are no data that examine the utility of the BSI as a routine screening tool in psychiatric emergency departments. Therefore, this study (a) examined whether the BSI could be routinely used in a psychiatric emergency service, (b) examined whether the BSI and clinician ratings of suicidality identified similar demographic and diagnostic characteristics of populations of patients with the use of logistic regression analysis and (c) identified demographic and diagnostic characteristics that were associated with disposition from a psychiatric emergency department. Our hypothesis is that models predicting self-report of suicidality, as measured by BSI scores, will be similar to models predicting clinician ratings of suicidality documented in the chart and that both BSI scores and clinician ratings of suicide will predict hospitalization.

Section snippets

Methods

In July 2001, the University of Michigan Hospital Psychiatric Emergency Services (PES) adopted the BSI as a routine screening instrument for all voluntary patients Age 18 and older presenting to PES. The BSI is part of the registration materials patients received upon presentation to PES and generally takes 5–10 min to complete. The BSI is a 21-item self-report instrument that can be used as a screening tool to detect and measure the severity of suicidal ideation in adults. The first 19 items

Demographics and diagnoses

A total of 735 patients ages 18 through 97 (mean=37.51, S.D.=13.52) were seen during the study period. Of the total sample, 319 (44%) were male and 413 (56%) were female; 577 (81%) were White, 113 (16%) were African American, 191 (26%) were married and 529 were single (73%). Two hundred ninety-three (44%) were unemployed, 218 (33%) were employed, 30 (4.5%) were retired, 66 (10%) were on disability and 54 (8%) were students. There were minimal missing data points in the demographic section of

Discussion

This study determined that the BSI could be routinely used as part of an evaluation in the PES. Sixty-six percent of patients returned a completed BSI without prompting from staff. Patients who were agitated or had psychotic illnesses were less likely to return a completed BSI.

BSI scores in this study did not correlate with demographic or diagnostic categories, which is similar to previous reports [9], [12]. However, patients who scored positive on the BSI were more likely to be women, White

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    More than half of participants reported past week SI including a substantial number of participants who reported current suicide plans and even preparation of a plan ‘such as buying a gun or saving up pills’ in the past week. Our self-report rates of ideation are higher than that reported in studies based on a psychiatrist's assessment [20–26] but are consistent with those found by self-administered surveys in both a psychiatric emergency clinic [25] and in psychiatric outpatients at a county-funded clinic [27]. The overall rate of self-reported history of SA is also consistent with that reported by Zisook and colleagues [27].

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    However, some studies found that clinicians commonly fail to uncover and/or document suicidality during initial face-to-face assessment (Malone et al., 1995; Bongiovi-Garcia et al., 2009; Healy et al., 2006). In contrast, semi-structured research interviews (Malone et al., 1995; Bongiovi-Garcia et al., 2009) as well as self-report questionnaires were more likely to reveal suicidal ideations than a face-to-face clinical interview (Yigletu et al., 2004; Kaplan et al., 1994; Healy et al., 2006). Psychiatric disorders play a very important role in the increased risk for suicide (Nock et al., 2008).

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