The Hidden Face of Emergencies: Psychiatric Consultations in the Emergency Department – Predictors of Psychiatric Admission and Treatment Refusal

Cyprus Turkish Journal of Psychiatry & Psychology, Early View

Published Online: 03 July 2026, Doi:10.35365/ctjpp.26.3.12

 RESEARCH ARTICLE / ARAŞTIRMA YAZISI

The Hidden Face of Emergencies: Psychiatric Consultations in the Emergency Department – Predictors of Psychiatric Admission and Treatment Refusal

Acillerin Görünmeyen Yüzü: Acil Serviste Psikiyatri Konsültasyonlarının Analizi-Psikiyatri Servisine Yatış ve Tedavi Reddi Belirleyicileri

Yasemin Koçyiğit¹ , Mehmet Rıdvan Varlı² , Kübra Özcan Çetin² , Şule Bıçakçı Ay¹

Abstract:

Individuals presenting to emergency departments (EDs) with psychiatric complaints often experience longer waiting times and lower quality of care than those with general medical conditions. Given the heterogeneity of this population, identifying its characteristics is essential for effective service planning and targeted interventions. This study examined the sociodemographic and clinical features of patients referred for psychiatric consultation in an ED, as well as factors associated with psychiatric inpatient admission and treatment refusal. This retrospective descriptive study included all patients aged ≥18 years who were referred from the ED to the psychiatry department between 6 October 2022 and 1 March 2024 (n = 2,146). Data were obtained from hospital records and analyzed using descriptive statistics and multivariable logistic regression. Women accounted for 53.9% of presentations, and 70.7% of consultations occurred outside regular working hours. The most common reason for consultation was a suicide attempt (21.0%), with drug ingestion accounting for 81.1% of these cases. The most frequently recorded diagnoses were psychotic, depressive, and anxiety disorders. Overall, 4.5% of patients were admitted to the psychiatric ward, and 5.6% were discharged following treatment refusal. Psychotic disorders, bipolar disorder in a manic or hypomanic episode, and suicide attempts involving drug overdose were associated with an increased likelihood of psychiatric admission, whereas management without psychotropic medication was associated with a reduced likelihood. Treatment refusal was more common among patients with an unclear psychiatric history and less frequent among those with a documented psychiatric diagnosis. These findings underscore suicide attempts and severe mental disorders as key priorities for emergency psychiatric care and highlight the importance of communication-focused strategies to reduce treatment refusal in the ED setting.

Keywords: Emergency departments, Emergency psychiatric services, Hospital admission, Treatment refusal, Suicide.

¹Specialist, Etlik City Hospital, Department of Psychiatry, Ankara, Türkiye.

²Psychiatry Resident, Etlik City Hospital, Ankara, Türkiye.

Address of Correspondence/Yazışma Adresi: Şule Bıçakcı Ay, Etlik City Hospital, Varlık Neighborhood, Halil Sezai Erkut Avenue, Yenimahalle District, Ankara 06170, Türkiye. E-mail: [email protected].

Date of Received/Geliş Tarihi: 14.10.2025, Date of Revision/Düzeltme Tarihi: 16.03.2026, Date of Acceptance/Kabul Tarihi: 26.03.2026, Date of Online Publication/Çevirimiçi Yayın Tarihi: 03.07.2026

Citing/Referans Gösterimi: Koçyiğit, Y., Varlı, M. R., Çetin, K. Ö., & Ay, Ş. B. (2026). Investigation of alexithymia levels and childhood trauma in mothers of sexually abused children, Cyprus Turkish Journal of Psychiatry & Psychology, 1-9, Doi:10.35365/ctjpp.26.3.12.

© 2026 The Author(s). Published by Cyprus Mental Health Institute / Cyprus Turkish Journal of Psychiatry and Psychology (www.ktppdergisi.com). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 license which permits use, sharing, adaptation, distribution and reproduction in any medium or format, provided the original work is properly cited and is not used for commercial purposes. https://creativecommons.org/licenses/by-nc-sa/4.0/