Pavarin R,Fioritti A,Marani S,Fontana F,Paparelli A,Boncompagni G.Emergency Department(ED) Admission and Mortality Rate for Suicidal Behaviour:a follow-up study on attempted suicide referred to the service between Jan.2004 and Dec.2010. Crisis 35(6),2014

Abstract
Aims: To describe the characteristics of the admission for suicide-related presenting complaints in EDs of the metropolitan area of Bologna; to estimate the mortality risk for all causes and for suicide; to identify the possible profiles of the subjects most at risk.
Methods: Follow-up of patients admitted to the Emergency Departments (EDs) of the metropolitan area of Bologna between January 2004 and December 2010 for attempted suicide.
Cox model was used to evaluate the association between socio-demographic variables and the general mortality risk.
Results: We identified 505 cases of attempted suicide, more frequent for females, over the week-end and in the night time (20.00/ 08.00). The most used suicide methods result to be the use of psychotropic drugs, sharp or blunt objects and jumping from high places.
In this cohort, 3.6% resulted in completed suicide (4.5% of males vs. 2.9% of females), 2.3% within one year of the start of the follow-up. 
The most common causes of death are drug use and hanging.
In the multivariate analysis, those who used illicit drugs 24 hours prior to admission to ED (HR 3.46 95% CI 1.23-9.73) and patients who refused the treatment (HR 6.74 95% CI 1.86-24.40) showed an increased mortality risk due to suicide.
Conclusions: Deliberate self-harm patients presenting to the Emergency Department (ED) who refuse treatment represent a specific target on which to set up dedicated prevention schemes.