Psychiatric Consultation for Suicidal Behaviour in Emergency Departments: A Comparison Between the University Hospital Systems of Alessandria and Novara

Background: Suicide attempts constitute a significant public health emergency, with Emergency Departments (EDs) serving as a primary point of contact for individuals in acute psychiatric distress. Methods: This observational, multicentric study aimed to analyse and compare the profiles of psychiatric consultations provided in the EDs of the University Hospital Systems (AOU) of Novara and Alessandria between January and December 2024, focusing specifically on suicidal behaviours, clinical characteristics, and intervention outcomes. Data were collected anonymously and pseudonymized from the institutional software (Track Care, REDCap). Results: The study included 1,196 accesses requiring psychiatric evaluation. Significant differences emerged between the centres: the Novara cohort was significantly younger (mean age 42.5 vs. 47.1 years; p < 0.001), presented with more complex, chronic psychiatric histories (76.3% previous psychiatric history vs. 57.3% in Alessandria; p < 0.001), and showed higher rates of suicidal ideation and low-lethality self-harm. Consequently, Novara utilised acute pharmacological therapy more frequently (51.13% vs. 39.59%; p < 0.001) and hospital admissions more often (voluntary admissions 40.74% vs. 25.85%; p < 0.001). Conversely, Alessandria’s population was older, often self-referred (58.4% vs. 34.7% in Novara), and showed a significantly higher frequency of conscious suicidal intent (will to self-preserve 39.68% vs. 23.36%; p = 0.024), often associated with high-lethality suicide methods (e.g., hanging 13.1%, defenestration 8.2%). Alessandria adopted a more territorial management approach, with higher discharge rates (27.23% vs. 18.89%) and referral rates to community mental health services (CSM) (21.23% vs. 17.96%). Conclusion: Multivariate analysis confirmed the gender paradox, showing that women were significantly associated with self-harm (Odds Ratio - OR = 1.57; p = 0.008). Crucially, substantial methodological differences were observed in substance use screening (Novara: 67.84% positive vs. Alessandria: 12.22% positive), underscoring the need to standardise diagnostic protocols for reliable epidemiological data. The findings highlight the need for tailored, integrated care models based on the specific demographic and clinical profiles served by local EDs. Trial registration: The study was approved by the Interaziendale Territorial Ethics Committee of the AOU Maggiore della Carità of Novara (Prot. n° 912/CE, July 3, 2023) and by the University of Piemonte Orientale.