Abstract
BackgroundThe aim was to study whether number of visits to emergency department (ED) is associated with suicide, taking into consideration known risk factors.MethodsThis is a population-based case–control study nested in a cohort. Computerized database on attendees to ED (during 2002–2008) was record linked to nation-wide death registry to identify 152 cases, and randomly selected 1520 controls. The study was confined to patients attending the ED, who were subsequently discharged, and not admitted to hospital ward. Odds ratio (OR) and 95% confidence intervals (CI) of suicide risk according to number of visits (logistic regression) adjusted for age, gender, mental and behavioral disorders, non-causative diagnosis, and drug poisonings.ResultsSuicide cases had on average attended the ED four times, while controls attended twice. The OR for attendance due to mental and behavioral disorders was 3.08 (95% CI 1.61-5.88), 1.60 (95% CI 1.06-2.43) for non-causative diagnosis, and 5.08 (95% CI 1.69-15.25) for poisoning. The ORs increased gradually with increasing number of visits. Adjusted for age, gender, and the above mentioned diagnoses, the OR for three attendances was 2.17, for five attendances 2.60, for seven attendances 5.97, and for nine attendances 12.18 compared with those who had one visit.ConclusionsNumber of visits to the ED is an independent risk factor for suicide adjusted for other known and important risk factors. The prevalence of four or more visits was 40% among cases compared with 10% among controls. This new risk factor may open new venues for suicide prevention.
Highlights
The aim was to study whether number of visits to emergency department (ED) is associated with suicide, taking into consideration known risk factors
Thanks to the universally used personal identification number and population registries, e.g. on causes of death and healthcare utilization, this population-based cohort can be prospectively followed and provides ideal circumstances to study risk factors for suicide, with epidemiological methods. Leveraging these resources, the aim of our study was to evaluate whether the number of visits to the ED is associated with completed suicide, while taking into consideration known risk factors
The records contain routinely collected data on every visit of ED attendees18 years or older, including the unique registration number of each visit, personal identification number according to the National Registry, birth date, gender, admission date, main discharge diagnosis according to ICD-10, and discharge date
Summary
The healthcare system can play an important role in the prevention of suicide [1] at least for prospective suicide victims that have had contact with healthcare services prior to their death [2,3] These healthcare contacts prior to suicide have been reported in a few descriptive studies with respect to the time when they occur prior to the suicide, with the main focus on hospital admission, mental health services, primary healthcare, and general practitioners. Analytical studies on this issue are rare. There are indications that frequent users of ED have increased mortality due to drug intoxication and suicide [6,16]; if confirmed in prospective investigations these systemic factors could be employed at EDs as a warning sign for potential suicide risk [11]
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