Predicting 3‐month risk for adolescent suicide attempts among pediatric emergency department patients

Predicting 3‐month risk for adolescent suicide attempts among pediatric emergency department patients · SciRah

^aDepartment of Psychiatry University of Michigan Ann Arbor MI USA
^bDepartment of Psychiatry, University of Michigan, Ann Arbor, MI, USA
^cDepartment of Emergency Medicine University of California, San Francisco San Francisco CA USA
^dDepartment of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA
^eDepartment of Psychiatry University of Pittsburgh Pittsburgh PA USA
^fDepartment of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
^gDepartment of Pediatrics University of Utah Salt Lake City UT USA
^hDepartment of Pediatrics, University of Utah, Salt Lake City, UT, USA
ⁱDepartments of Pediatrics, Psychiatry and Behavioral Health Ohio State University College of Medicine Columbus OH USA
^jDepartments of Pediatrics, Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus, OH, USA
^kDepartment of Psychiatry and Human Behavior Brown University Providence RI USA
^lDepartment of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
^mDepartment of Emergency Medicine Columbia University New York NY USA
ⁿDepartment of Emergency Medicine, Columbia University, New York, NY, USA
^oDepartment of Pediatrics University of Cincinnati Cincinnati OH USA
^pDepartment of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
^qDepartments of Pediatrics and Emergency Medicine University of Colorado School of Medicine Aurora CO USA
^rDepartments of Pediatrics and Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
^sMedical Center University of California Davis School of Medicine Sacramento CA USA
^tMedical Center, University of California Davis School of Medicine, Sacramento, CA, USA
^uDepartment of Pediatric Emergency Medicine University of Utah Salt Lake City UT USA
^vDepartment of Pediatric Emergency Medicine, University of Utah, Salt Lake City, UT, USA
^wDepartments of Emergency Medicine and Pediatrics University of Michigan Ann Arbor MI USA
^xDepartments of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, MI, USA
^yDepartment of Pediatrics Baylor College of Medicine Houston TX USA
^zDepartment of Pediatrics, Baylor College of Medicine, Houston, TX, USA
^aaDepartment of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
^abDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
✉Corresponding author

Abstract

BACKGROUND: The incidence of adolescent suicide is rising in the United States, yet we have limited information regarding short-term prediction of suicide attempts. Our aim was to identify predictors of suicide attempts within 3-months of an emergency department (ED) visit. METHODS: Adolescents, ages 12-17, seeking health care at 13 pediatric EDs (Pediatric Emergency Care Applied Research Network) and one Indian Health Service Hospital in the United States were consecutively recruited. Among 10,664 approached patients, 6,448 (60%) were enrolled and completed a suicide risk survey. A subset of participants (n = 2,897) was assigned to a 3-month telephone follow-up, and 2,104 participants completed this follow-up (73% retention). Our primary outcome was a suicide attempt between the ED visit and 3-month follow-up. RESULTS: One hundred four adolescents (4.9%) made a suicide attempt between enrollment and 3-month follow-up. A large number of baseline predictors of suicide attempt were identified in bivariate analyses. The final multivariable model for the full sample included the presence of suicidal ideation during the past week, lifetime severity of suicidal ideation, lifetime history of suicidal behavior, and school connectedness. For the subgroup of adolescents who did not report recent suicidal ideation at baseline, the final model included only lifetime severity of suicidal ideation and social connectedness. Among males, the final model included only lifetime severity of suicidal ideation and past week suicidal ideation. For females, the final model included past week suicidal ideation, lifetime severity of suicidal ideation, number of past-year nonsuicidal self-injury (NSSI) incidents, and social connectedness. CONCLUSIONS: Results indicate that the key risk factors for adolescent suicide attempts differ for subgroups of adolescents defined by sex and whether or not they report recent suicidal thoughts. Results also point to the importance of school and social connectedness as protective factors against suicide attempts.

Predicting 3‐month risk for adolescent suicide attempts among pediatric emergency department patients

Abstract

Plain-language summary

Discussion