Consultation-liaison psychiatric service utilization by suicide attempters

Abstract

Context: There is sparse Indian literature on consultation-liaison psychiatric (CLP) service utilization by suicide attempters who generally present first to the accident and emergency departments and are seen by the psychiatrist only after the initial stabilization.

Aims: The aim of the study is to study the psychiatric referral, review, and psychopharmacological intervention rates among suicide attempters and to study factors associated with psychiatric referral.

Settings and design: Retrospective, medicolegal case register-based, explorative analysis of suicide attempters presents to a rural tertiary care hospital in south India.

Subjects and methods: Eight hundred and twenty-nine medicolegal case files of individuals whose diagnosis was recorded as either suicidal attempt, deliberate or intentional self-harm, and poisoning or hanging were analyzed for different variables.

Statistical analysis used: Descriptive frequencies, Pearson's Chi-square and logistic regression analysis to know the association of psychiatric referral with different variables, were performed using the Statistical Package for the Social Sciences, version 16.

Results: A little more than half of the suspected suicide attempters (51.4%) were referred for psychiatric review, and majority of those referred (93.7%) were reviewed by the psychiatrist. Psychiatric referral was significantly associated with a relatively younger age, positive past and family history of suicidal behavior, mode of attempt (pesticide poisoning and attempted hanging were more likely to be referred), and a longer duration of hospitalization.

Conclusions: The low referral rate but an overwhelming review rate among those referred shows that probably referrer factors are responsible for this and so CLP for suicide attempters needs to be strengthened by sensitizing the referring doctors on the importance of the psychiatric referral and the need to avoid discharge within the first 24 h.

Keywords: Pesticide poisoning; psychiatric referral; psychiatric review; service utilization; suicide attempters.

Figure 1

Psychiatric service utilization by suicide attempters