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Emergency department study reveals patterns of patients at increased risk for suicide
A new study found that people who presented to California emergency departments with deliberate self-harm had a suicide rate in the year after their visit 56.8 times higher than those of demographically similar Californians.
Depression is a major suicide risk. Photo: Gabriel/Unsplash
People who presented with suicidal ideation had suicide rates 31.4 times higher than those of demographically similar Californians in the year after discharge. The findings reinforce the importance of universal screening for suicide risk in emergency departments and the need for follow-up care.
“Until now, we have had very little information on suicide risk among patients after they leave the emergency department. Understanding the characteristics and outcomes of people with suicide risk who visit emergency departments is important for helping researchers and practitioners improve treatment and outcomes,” said lead author Sidra Goldman-Mellor, Ph.D., an assistant professor of public health at the University of California, Merced.
Goldman-Mellor and colleagues sought to understand patterns of suicide and other mortality in the year after emergency department presentation — and patient characteristics associated with suicide death — by linking emergency department patient records from California residents who presented to a licensed emergency department between Jan. 1, 2009, to Dec. 31, 2011, with California mortality data.
The researchers divided individuals presenting to the emergency department into three groups: people with deliberate self-harm with or without co-occurring suicidal ideation (85,507 patients), people presenting with suicidal ideation but without deliberate self-harm (67,379 patients), and people without either self-harm or suicidal ideation, called “reference” patients (497,760 patients).
The researchers found that the probability of suicide in the first year after discharge from an emergency department was highest — almost 57 times that of demographically similar Californians overall — for people who had presented with deliberate self-harm. For those who presented with suicidal ideation, the suicide rate was approximately 31 times higher than among Californians overall.
The suicide rate for the reference patients was the lowest amongst the studied groups, but still double the suicide rate among Californians overall.
The risk for death via unintentional injury (i.e., accidents) was also markedly elevated — 16 times higher for the deliberate self-harm group and 13 times higher for the ideation group than for demographically similar Californians.
Most deaths due to unintentional injury were found to be due to overdose — 72% in the self-harm group and 61% in the ideation group — underscoring the overlap between suicide and overdose risk.
The researchers also examined if certain clinical or demographic characteristics measured at the emergency department visit were predictive of subsequent suicide death.
For all three groups, men and those over the age of 65 had higher suicide rates than women and people 10-24 years of age. In all groups, suicide rates were higher for non-Hispanic white patients than for patients of other ethnicities.
Comorbid diagnoses were also found to be associated with suicide risk, but differently for each of the three groups studied. For patients who had presented with deliberate self-harm, those with a comorbid diagnosis of bipolar disorder, anxiety disorder, or a psychotic disorder were more likely to die by suicide than those without these co-occurring diagnoses.
For patients who presented with suicidal ideation, a comorbid diagnosis of depression was found to be associated with increased suicide risk. Among reference patients, patients with bipolar disorder, depression, or alcohol use disorder had an increased risk of suicide.
Of note, patients in the deliberate self-harm group who presented to the emergency department with a firearm injury had a subsequent suicide rate in the following year of 4.4%, far higher rate than any other patient group in this study. (National Institutes of Health)
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