Characteristics of patients presenting post-suicide attempt to an Academic Medical Center Emergency Department in Lebanon

Imad El Majzoub,Maha Makki,Gilbert Abou Dagher,Karim Hajjar,Christopher El Khuri,Ralphe Bou Chebl,Aurelie Mailhac,Farid Talih

doi:10.1186/s12991-018-0191-5

Imad El Majzoub, Maha Makki + Show 6 more

Open Access

https://doi.org/10.1186/s12991-018-0191-5

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Abstract

BackgroundEmergency Department (ED) visits for suicide attempts have been described worldwide; however, the populations studied were predominantly Western European, North American, or East Asian. This study aims to describe the epidemiology of ED patients presenting post-suicide attempt to an academic medical center in Lebanon and to report on factors that affect ED disposition.MethodsA retrospective cohort study was conducted between 2009 and 2015. Patients of any age group were included if they had presented to the ED after a suicide attempt. Patients with unintentional self-harm were excluded. Descriptive analysis was performed on the demographics and characteristics of suicide attempts of the study population. A bivariate analysis to compare the two groups (hospitalized or discharged) was conducted using Student’s t test and Pearson Chi-square where appropriate. A multivariate analysis was then conducted to determine the predictors of hospital admission.ResultsOne hundred and eight patients were included in the final analysis. Most patients were females (71.4%) and between 22 and 49 years of age. A considerable number of patients were unemployed (43%), unmarried (61.1%), and living with family (86.9%). Most suicide attempts were performed at home (93.5%) and on a weekday (71.3%). The most common mechanisms of injury were overdose with prescription medications (61.3%), overdose with over-the-counter drugs (27.9%), and self-inflicted lacerations (10.1%). The classes of medication most commonly abused were benzodiazepines (39.3%) followed by acetaminophen (27.3%). A large portion of our patients were admitted (70.3%), with the majority going to the psychiatric ward (71.1%). Of note, a quarter (27.5%) of our patients left the ED against medical advice, with 23.5% of admitted patients leaving the hospital before completion of treatment. The main predictors of admission were found to be overdose on prescription medications OR 9.25 (2.12–40.42 CI95%).ConclusionsThe characteristics of our suicide attempters mirror those of international and regional suicide attempters. Further work is required to quantify the effect of voluntary refusal of hospital treatment, the repercussions of family, and financial barriers to healthcare and suicide as a whole in our society.

Highlights

Emergency Department (ED) visits for suicide attempts have been described worldwide; the populations studied were predominantly Western European, North American, or East Asian
One-third of the patients (35.8%) noted that their relationship or marriage was directly associated with their suicide attempt, with 10.5% noting that it contributed indirectly
This study aims to add to the literature of suicide attempters presenting to the ED and sheds light on their demographics, previous psychiatric history, and detailed mechanism of suicide along with hospital disposition

Summary

Introduction

Emergency Department (ED) visits for suicide attempts have been described worldwide; the populations studied were predominantly Western European, North American, or East Asian. This study aims to describe the epidemiology of ED patients presenting post-suicide attempt to an academic medical center in Lebanon and to report on factors that affect ED disposition. Haukka et al [6] mention that the single strongest factor that predicts suicide is a prior history of a suicide attempt. It is, important to better understand these patients, so as to tailor preventative efforts

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