Background There are 2,000 suicides among children and adolescents annually. A third of teenagers committing suicide have previously been hospitalized for an attempt. The psychosocial management during in-hospital medical stabilization of a suicide attempt may be critical in preventing reoccurrence of suicidal behavior.
Purpose To compare evidence in the medical chart of psychosocial management in the hospital to the standards established by the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry.
Methods The Pediatric Health Information System database was used to compile a list of individuals, aged 10-20, admitted to a large children's hospital between April 1998 and January 2003 with ICD-9 E-codes as follows: self-inflicted injury (950-959), accidental self-poisonings related to medications (850-859), and/or injury undetermined (980-989). Abstraction of medical charts was completed for 90 adolescents. Mortalities during hospitalization were excluded.
Results Consistent with guidelines, all patients received an evaluation by either a psychiatrist (96%), social worker (92%), or both (89%). Less complete correspondence with professional guidelines was noted for the following: efforts to establish the importance of treatment with family (6.8%), prescription of SSRIs among depressed adolescents (27.9%), suicidality stabilized prior to discharge home (80%), effort to sanitize the home of firearms and lethal medications (7.8%), and evidence of adult supervision among those discharged home (45%). Discharge to a psychiatric facility versus to the home was more likely among adolescents who were depressed (OR 7.9, p < .01), delusional (OR 6.3, p < .05), had previous suicide attempt (OR 5.7, p < .001), and had continued suicidal ideation (OR 17.1, p < .0001).
Conclusions Evidence from a chart-based review shows that quality of care differs from national guidelines. Standardized psychosocial assessment procedures during medical hospitalization should be developed and implemented to ensure the safety of adolescents who attempt suicide.
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