Clinical symptoms and risk factors in people with mental disorders: findings from the interRAI emergency screener for psychiatry in Brazil

TL;DR

This study identifies risk factors for suicide and aggression among mental health patients in Brazilian emergency rooms using a screening tool.

Contribution

The study introduces the use of the interRAI emergency screener in Brazil to identify risk factors for suicide and aggression in mental health patients.

Findings

Depression severity, risk of harm to others, and social withdrawal were risk factors for suicide attempts.

Mania and multiple hospitalizations were linked to hetero-aggression risk.

The screener proved effective in emergency settings for identifying these risks.

Abstract

Emergency rooms in general hospitals receive patients experiencing acute crises, exacerbations of chronic mental disorders, and psychiatric emergencies. This study aims to describe the main characteristics and clinical symptoms of the sample of mental health patients across main diagnoses, and to identify the risk factors of suicide, as well as of hetero-aggression. This study aims to investigate the associations between clinical symptoms, risk factors for suicide attempts and hetero aggression, and psychiatric diagnoses in patients with mental disorders and addictions.

This is a quantitative, cross-sectional, and analytical study. The Emergency Screener for Psychiatry instrument was applied to screen patients in an Emergency Care Unit in Primary Health Care and a Mental Health Unit of a University Hospital in Brazil. A comparative analysis of the main characteristics of patients between the sites was conducted. Logistic models were used to identify risk factors of suicide attempts and hetero aggression.

The scales of depression severity (OR:2.69), risk of harm to others (OR:3.31), and social withdrawal (OR:4.27) were identified as risk factors for suicide attempts. A protective factor was the item reporting if family/friends or professionals are concerned about the patient’s self-harm (OR:0.34). For hetero-aggression risk, using the harm to others scale, only the mania scale (OR:4.31) and history of four or more previous hospitalizations (OR:2.80) were significant. In both models, no significant associations were found for the type of diagnosis or the patient’s admission site.

The Emergency Screener for Psychiatry proved to be a useful screening instrument to identify risk factors of suicide attempts and hetero aggression of patients in emergencies settings and general hospitals.