R. ZUMBRUNNEN and L. TRICOT
Assessment and therapeutic orientation of suicidal patients accounts for an important part--both quantitatively and qualitatively--of the activity of most psychiatric consultation-liaison units in general hospitals. The significance and seriousness of self-harmful acts are quite different from one patient to another, therefore clinical assessment and decision depend on many variables. Numerous suicidology articles and textbooks provide guidelines for clinical assessment and management of suicidal patients ( Hawton and Catalan, 1987, pp. 58-87; Kreitman, 1986, pp. 181-95; Gunn-Sechehaye, 1986, pp. 77-91). Other authors propose standardised rating scales as an aid to clinical evaluation and prediction of suicidal behaviour ( Resnick, 1980, Pattersonet al., 1983; Victoroff, 1983, pp. 67-77; Mottoet al., 1985; Poeldinger, 1983). Another interesting approach, which is beginning to arouse interest among clinicians and researchers, consists of studying the determinants of psychiatric decision-making ( Hermann, 1984).
The present study was conducted in order to investigate the impact of some factors on therapeutic decision-making following a suicide attempt. A recent research overview ( Marsonet al. 1988) stressed the multiplicity of variables related to clinical decision in the emergency room: influences (and interactional influences) such as demographic, clinical and those of clinician, family and health system were reviewed. Unfortunately, emergency room psychiatric pathology is very heterogeneous, and no study specifically devoted to the decision-making process following suicidal behaviour could be found in the literature.
In the Canton and City of Geneva (area population 360 000),