Death by Suicide Associated With Recent ED Visits, Hospital Admissions

People who die by suicide are more likely than control patients to have attended an emergency department (ED) or to have been admitted to hospital in the 3 months before their death, according to a study published in the Journal of Affective Disorders.

Siobhan O’Neill, PhD, from the Psychology Research Institute, Ulster University, Coleraine, Northern Ireland, and colleagues used case-control methodology and administrative data on all death by suicide in Northern Ireland between January 1, 2012, and December 31, 2015, to explore patterns of ED attendance and hospital admissions among those who have died by suicide.

The investigators used age- and sex-matched controls who were alive at the time of death for the control group. They included 5 controls for each death, resulting in a study population of 1105 cases and 5525 controls for a total study population of 6630.

Of the cohort, 32.5% of people who died by suicide visited the ED department in the 2 years before their death compared with 16.9% of those in the control group. This was particularly true in the 3 months before death, with 12.9% of cases attending the ED during that period compared with 3.3% in the control group. Furthermore, 41.9% of the people who died by suicide had been admitted to the hospital in the 2 years before death compared with 14.3% in the control group. In the 3 months before death, nearly 20% of those who died by suicide had been admitted to the hospital admission, whereas only 3.8% of controls had a hospital admission.

Risk for death by suicide was also found to be higher among those living in the most deprived areas of the country, at 21.0% of cases vs 10.7% of controls, as well as among those living in urban areas, at 72.8% of cases vs 63.0% of controls. Death by suicide was also more prevalent between the ages of 20 and 54 years and in males, who make up 75.75% of deaths by suicide.

“[The results suggest] that many of those who die by suicide do not [recognize] the signs of mental illness or seek support for suicidal thoughts,” the investigators wrote. “These findings also support the use of carefully designed anti stigma campaigns and efforts to encourage people to disclose suicidal ideation and seek treatment and support. Broader education in relation to the warning signs for suicidal [behavior] and how to support people to access services is also recommended.”

Reference

O’Neill S, Graham B, Ennis E. Emergency department and hospital care prior to suicide: a population based case control study. J Affect Disord. 2019;249:366-370.