Emergency department (ED) visits for suicide attempts (SA) and suicidal ideation (SI) doubled in youth in the United States between 2007 and 2015, according to research results published in JAMA Pediatrics. Suicide is the second leading cause of death among youth 10 to 18 years old, representing a chief public health concern.
The researchers hypothesized that they would observe an increasing number of ED visits for pediatric SA/SI and performed a repeated cross-sectional analysis of the National Hospital Ambulatory Medical Care Survey ED database from 2007 to 2015. The data included approximately 30,000 visits to 300 EDs. The study included children 18 or younger and the primary outcome was children age 5 to 18 years with a main complaint or discharge diagnosis of SA or SI. To account for the sampling design, researchers applied survey-weighted procedures and evaluated trends using a weighted Pearson χ2 test of proportions.
During the 9 years, 1613 observations out of 59,921 unweighted ED visits met the study inclusion criteria. The median age of participants was 13 years. Investigators noted that 43.1% of SA/SI visits were for children 5 to 11 years old, of whom only 2.1% were hospitalized. Over the 9 years, annual visits for SA/SI increased from 580,000 to 1.12 million, while there was no significant change in total ED visits. Proportionately to all pediatric ED visits, SA/SI increased from 2.17% in 2007 to 3.50% in 2015. In a similar fashion, ED visits for SA alone increased from 540,000 to 960,000.
The study was limited by possible misclassifications of non-suicidal self-harm, as well as the analysis grouping SA and SI together, rather than assessing them individually or along a spectrum.
The analysis overall demonstrated that ED visits for SA/SI in youth doubled between 2007 and 2015. This trend runs parallel to a 2-fold increase in SA/SI visits to children’s hospitals in the United States during that time period.
“Findings suggest a critical need to augment community mental health resources, ED physician preparedness, and post–emergency department risk reduction initiatives to decrease the burden of suicide among children,” investigators concluded.
Burstein B, Agostino H, and Greenfield B. Suicidal attempts and ideation among children and adolescents in US emergency departments, 2007-2015 [published online April 8, 2019]. JAMA Pediatr. doi:10.1001/jamapediatrics.2019.0464