Substance Use as a Mediator of the Association Between Demographics, Suicide Attempt History, and Future Suicide Attempts in Emergency Department Patients.

Abstract

Identification of factors that predict and protect against attempted suicide are critical for the development of effective suicide prevention and intervention programs. To examine whether substance use mediates the association between demographic characteristics, suicide attempt history, and reports of a suicide attempt within 12 months after screening positive for active suicidal ideation or behavior during the index emergency department (ED) visit. Data were collected during the first two phases of the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study. Data collection included baseline interview; 6- and 12-month chart reviews; and 6-, 12-, 24-, 36-, and 52-week telephone follow-up assessments. Structural equation modeling was used. All p values were two-tailed, with p < .05 considered statistically significant. Among the 874 subjects, 195 (22%) reported a suicide attempt within 12 months after the index ED visit. Of participants reporting a suicide attempt, 59% were < 40 years old, 59% female, and 76% non-Hispanic White. Associations between race, sex, and suicide attempt 12 months after the index ED visit may be mediated by a combination of alcohol misuse and cocaine use. Findings from the mediation analyses provide insight into the impact of substance use on future suicide attempts in various sociodemographic groups.