Does Psychiatric Hospitalization of Suicidal Emergency Department Patients Reduce Risk of Subsequent Suicidal Behaviors?

Department of Epidemiology Seminar Series

Open to the public

Speaker:

Ronald C. Kessler, PhD
McNeil Family Professor of Health Care Policy
Department of Health Care Policy
Harvard Medical School

Abstract: Psychiatric hospitalization is the standard of care for emergency department (ED) patients with high suicide risk. However, the effect of hospitalization in reducing subsequent suicidal behaviors is poorly understood and likely heterogeneous. This uncertainty is of considerable practical importance given the current ED boarding crisis. We examined heterogeneity in the association of psychiatric hospitalization with subsequent suicidal behaviors based on observational EHR and geospatial data in the Veterans Health Administration (n=196,610 ED visits). A preliminary individualized treatment rule (ITR) was developed in a 70% training sample to optimize hospitalization decisions. Hospitalization was associated with significantly reduced risk of subsequent SAs in 28.1% of patients and increased risk in 24.0% in the 30% test sample. If causal, an ITR based on these associations would reduce SAs by 16.0% and hospitalizations by 13.0% compared to current rates. A pilot experiment testing the value of the ITR is currently underway in VHA.