• Ki Young Jeong, Seok Hoon Ko, Han Sung Choi, and Jong Seok Lee.
• Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea; Department of Emergency Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea; Center for Suicide Prevention, Kyung Hee University Medical Center, Seoul, Republic of Korea. Electronic address: emergency0599@khu.ac.kr.
• Am J Emerg Med. 2021 Sep 1; 47: 131-137.

BackgroundDuring the process of managing suicide attempters in the emergency department (ED), the importance of hospitalization has been emphasized. Lethality and intent have been suggested as hospitalization determinants of suicide attempters, but their predictive values remain limited in adult and elderly populations.MethodsUsing prospectively collected the ED-based Suicide Registry, data from suicide attempters over 18 years old was retrospectively studied (2010-2020). The enrolled participants were divided into adult (N = 832) and elderly (>65 years, N = 378) groups. Suicide lethality and intent were assessed by the Risk-Rescue Rating Scale (RRRS) and Suicide Intent Scale (SIS), respectively. The moderating effects of age on the relationship between the psychological scales and hospitalization were examined by entering the interaction terms into a multivariable regression model. The predictive ability of each scale for hospitalization was evaluated in terms of performance and goodness-of-fit.ResultsBoth scales' scores in both age groups were significantly higher in hospitalized patients than non-hospitalized patients. Interaction result indicated that only the odds of RRRS for hospitalization significantly differed by age group. Moreover, the predictive performance for hospitalization significantly differed by age group in RRRS but not SIS. In predicting hospitalization, the AUC of the RRRS was significantly higher than that of the SIS in the elderly group but not in the adult group. Comparing the two groups, the RRRS of the elderly group tended to have higher AUC than the adult group, whereas the AUC of the SIS was similar. The RRRS in both groups had a better overall fit compared to the SIS for hospitalization, but its best overall fit and strength with greater power were observed in the elderly group.ConclusionsThe age-by-RRRS interaction is significantly associated with hospitalization, and the RRRS implementation as a hospitalization determinant is more useful and suitable for elderly suicide attempters than for adult suicide attempters in an emergency setting.Copyright © 2021 Elsevier Inc. All rights reserved.

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