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16792

School Referrals for Suicides: Are They Being Over-Labeled?

Saturday, October 20, 2012: 9:02 AM
Room 270 (Morial Convention Center)
Muhammad Waseem, MD1, Raquel Diaz-Guerrero, MD2, Rosario Cosme, MD2, Felix Rodriguez, MD2, Toussaint Reynolds, MD3, Yumna Ain1 and Mark Leber, MD1, (1)Emergency Medicine/Pediatrics, Lincoln Medical & Mental Health Center, Bronx, NY, (2)Psychiatry, Lincoln Medical & Mental Health Center, Bronx, NY, (3)Emergency Medicine, Lincoln Medical & Mental Health Center, Bronx, NY

School Referrals for Suicides: Are They Being Over-Labeled?

Background

In most physicians' minds, a suicidal complaint carries with it an ominous prognosis requiring intensive evaluation and treatment. We evaluated the hypothesis by first defining what an intensive psychiatric evaluation would be and then determining what percentage of suicidal children received this evaluation.

Objectives

To determine the proportion of children labeled as suicidal ideation who had a significant psychiatric intervention referred from schools to the Emergency Department (ED).

 

Methods

All medical records were reviewed from children who:

1)      Presented to the ED

2)      Had a diagnosis of suicidal ideation or threat

3)      Had a psychiatric consultation.

 

We then determined whether the child had a “significant psychiatric intervention” defined as one of the following:

1)      Hospitalization in a psychiatric facility

2)      A period of observation in the ED (>12 hours).

3)      Use of restraints

4)      Prescribing psychiatric medication.

Suicidal labeling was considered “appropriate” if one or more of the above interventions were recommended by a psychiatrist. It is assumed that almost 100% of children, labeled as suicidal ideation, would have a significant psychiatric intervention.

Results

581 medical records were examined. 160 (27.5%) were labeled suicidal and 421 (72.5%) labeled behavioral problems. Psychiatric interventions were equally appropriate in boys and girls (73.7% versus 67.6%; P=.109). 318/421 (75.5%) with a behavioral disorder had a significant psychiatric intervention compared to 105/160 (65.6%) of suicidal ideation (P=.004). This 65.6% is significantly different (P<.001) from a priori assumption that 100% of children labeled as suicidal ideation would have a significant psychiatric intervention.

Conclusions

By our definition, for significant psychiatric intervention, a significant percentage did not receive this. These results call into question the accuracy of suicide labeling.