Suicide and Self-Harm Outcomes Among Psychiatric Emergency Service Patients Diagnosed As Malingering

Abstract

Background: Malingering is a common and challenging clinical presentation in emergency departments (EDs).

Objective: This study describes characteristics and outcomes among patients diagnosed as malingering in a psychiatric emergency service.

Methods: Index psychiatric ED encounters were identified for all adult patients seen during a 27-month period. Mortality data were obtained for patients from the state public health authority, and repeat ED visits for self-harm were obtained from the state hospital association. Patients with a diagnosis of malingering were compared with those without a malingering diagnosis using correlative statistics and multivariable analyses.

Results: Of 4710 encounters analyzed, 236 (5%) had a malingering diagnosis. No patients diagnosed as malingering died of suicide within 365 days of discharge, compared with 16 (0.4%) nonmalingering patients. Self-harm outcomes were available for 2689 encounters; 129 (5%) had a malingering diagnosis. Malingering was significantly associated with a repeat ED visit for self-harm within 365 days in multivariable analyses (adjusted odds ratio 2.52; 95% confidence interval 1.35-4.70); p < 0.01).

Conclusions: No psychiatric emergency service patients diagnosed as malingering died by suicide after discharge. New clinical approaches must balance malingering patients' apparent low suicide risk with their other substantial comorbidities and risk for self-harm.

Keywords: Behavioral emergencies; Emergency psychiatry; Malingering; Psychiatric emergency services; Self-harm; Suicide.