One Thousand Referrals to General Adult Psychiatry: Suicidal Ideation, Clinical Characteristics, and Suicide.

Aims and Method: Questions often follow the suicide of someone who presented to General Adult 22 Psychiatry (GAP) when expressing suicidal thoughts: ‘Why were they not admitted, or managed 23 differently, when they said they were suicidal?’ Answering these questions requires knowledge of 24 the prevalence of suicidal ideation in patients presenting to GAP. Therefore, we determined the 25 general clinical characteristics, including suicidal ideation, of a large sample of presentations to a 26 GAP emergency assessment service and non-emergency referral meetings.

Results: Suicidal 27 ideation was very common being present in 76.4% of emergency presentations and 33.4% of non28 emergency referrals, and extremely weakly associated with suicide. It was higher in some diagnostic 29 categories than others, and previous assessment by GAP did not appear to affect it. The suicide rate 30 during the contingent episode of care was estimated as 66 per 100,000.

Clinical Implications: This, 31 and other evidence, shows that suicide cannot be predicted with an accuracy that is useful for 32 clinical decision making. This is not widely appreciated but has serious consequences for patients 33 and healthcare resources.