Should Let Them Go? Study on the Emergency Department Discharge of Patients Who Attempted Suicide

OBJECTIVE: The purpose of this study was to analyze the characteristics and factors of voluntary discharged patients after suicide attempt and analyze the effectiveness of follow-up measures. METHODS: Total 504 adult patients aged 14 years and over, who visited a local emergency medical center from September 1, 2013 to December 31, 2015 were enrolled and retrospectively reviewed. We analyzed the relationship with voluntary discharge group (VDG) among basic characteristics, suicidal attempt variables, outcome variables related to suicide attempts, and treatment related variables comparing with normal discharge group (NDG). RESULTS: Of the total 504 suicide attempts, three hundred eleven (61.7%) patients were VDG and 193 (38.2%) were NDG. The proportion of patients who completed the community service linkage were 18.7% (36/193) in NDG, compared with 7.7% (24/311) in VDG (p < 0.05). In addition, the ratio of the patients who visited psychiatric outpatient department in NDG were 57.0% (110/193), more than four times as likely as 14.5% (45/311) in VDG (p < 0.05). CONCLUSION: Over sixty percent of suicide attempters discharged against medical advice. Further various aspects of national supportive measures including strengthening case management service should be considered.

Case management of suicide attempters seen in emergency rooms: result and factors affecting consent to follow-up

OBJECTIVE: The purpose of this study was to identify the factors that influence the consent of case management for suicide prevention. METHODS: This study included 232 suicide attempters from September 1, 2015 to August 31, 2016 at the Emergency Medical Center of Soonchunhyang University Bucheon Hospital, Korea. A retrospective chart analysis was performed using a chi-square test or Fisher exact test, as well as univariate and multivariate logistic regression analysis (R ver. 3.3.3). RESULTS: The positive factors affecting case management consent were direct face-to-face counseling with a case manager, patient's age, suicide attempt without alcohol, first suicide attempt, and no psychiatric history. In addition, suicide attempters who underwent follow-up case management were more likely to participate in outpatient mental health care. Through the case manager, continuous emotional support and encouragement were provided to the suicide attempt, which proved to be effective. CONCLUSION: This study emphasizes the importance of case management for suicide attempters visiting the emergency medical center and suggests that the cooperation of national and regional systems should be expanded to increase the case participation rate.