Suicidal ideation and sobriety: Should acute alcohol intoxication be taken into account for psychiatric evaluation?

Abstract

BackgroundWhen evaluating an emergency department (ED) patient who presents with suicidal ideation, it is a common practice to wait until the patient’s ethanol level is known or calculated to be less than 80 mg/dl to evaluate patient safety. We know of no study that establishes an association between the degree of alcohol intoxication based on a blood alcohol level (BAL) and reported suicidal ideation (SI) upon recovery.MethodsWe conducted a retrospective review of patients evaluated in a Midwestern ED for the calendar year 2017. Cases were selected if they had a psychiatric social work consult and a blood alcohol level drawn while in the ED. Patients were selected on the same 2 days each week throughout the year to meet the sample size requirements of the study, resulting in 1084 cases for review. Chi‐square analysis was used to evaluate the relationship between suicidal ideation and alcohol intoxication as defined by a BAL ≥80 mg/dl.ResultsAmong patients presenting with suicidal ideation and a concurrent BAL ≥80 mg/dl, 69% no longer reported suicidal ideation when their BAL was <80 mg/dl, compared to 38% for patients without a positive BAL on presentation (chi‐square, p = 0.000012).ConclusionOur data show that patients presenting to the ED with complaints related to suicidal behavior who have a BAL ≥80 mg/dl are more likely to no longer endorse having suicidal ideation once their BAL is < 80 mg/dl than patients with similar presenting complaints and no alcohol intoxication. This finding supports the common ED practice of re‐assessing suicidal ideation among individuals who are initially intoxicated once their BAL has decreased below 80 mg/dl.Is sobriety from alcohol necessary for the evaluation of patients presenting with suicidal ideation? This retrospective study examines the association between the degree of alcohol intoxication of patients who presented to the emergency department (ED) with suicidal ideation (SI) and their final determination of suicidality upon sobriety. The study found that suicidal patients who presented with alcohol intoxication were much less likely to express SI upon sobriety than those who presented without being intoxicated.