Suicide-related Visits Research Articles

Evaluating the impact ofthe Community Helpers Program on adolescents 12-18 years old in Edmonton, Canada.

Alberta Health Services (AHS) Community Helpers Program (CHP) to enhance mental health among youth. Identifying the impact of CHP on mental illness-related acute care use among adolescents aged 12-18 years in Edmonton and determining cost avoidance. Using administrative data from AHS, public school catchment area data from theEdmonton Public School Board, and area-level socioeconomic deprivation status indicators from the Pampalon deprivation index, we applied geographical regression discontinuity design to estimate the effect of CHP implementation on depression-, anxiety-, and suicide-related acute care use (emergency department visits and inpatient admissions). Cost data were derived from Interactive Health Data Application of Alberta Health. The study period (2002-2022) included pre (2002-2011) and post (2012-2020) CHP implementation periods. CHP had statistically significant impact when distance from the boundary (catchment area identifier to divide the sample into treated and control groups) was between 600 and 800 m. About 90 and 80 fewer anxiety- and depression-related visits (per 1000 visits) were observed among individuals aged 12-15 and 16-18 years, respectively, in catchment areas of the public schools where CHP was implemented. Impact of CHP on suicide-related visits was only statistically significant among individuals aged 12-15 years. Annual cost reduction ranged from $161,117 to $269,255 for anxiety- and depression-related visits. Findings show contextual effect of CHP; i.e., being potentially exposed to the program reduced the likelihood of anxiety- and depression-related visits. Costs of CHP implementation could be compared with the avoided costs to assess economic benefits of implementing CHP.

COVID-19 and the impact on psychiatric and suicide-related emergency department visits of 5–18-year-Old youth in Israel

COVID-19 has been found to take a toll on the mental health of children and adolescents worldwide. This study retrospectively evaluated the changes in the number of general and suicide-related visits to a pediatric psychiatric emergency department (ED) at Geha Mental Health Center in Israel and the distribution of sex and age of the 5-18-year-old youth who visited the ED. The study looked at visits from the pre-pandemic years to the first and second years of the pandemic. The findings showed a sharp decrease in visits at the beginning of the pandemic, followed by a significant increase in the first year and a nonsignificant decline in the second year. The proportion of girls’ ED visits was higher in the pandemic years compared to the pre-pandemic years. Regarding suicide-related visits, after a sharp decline at the beginning of the pandemic, the number of visits increased at a rate similar to the pre-pandemic period. We conclude that the pattern of change was similar to that of other population-level exposures to continuous stress conditions. Further research on the vulnerability of girls in similar situations is needed.

National Trends in Mental Health–Related Emergency Department Visits Among Youth, 2011-2020

There has been increasing concern about the burden of mental health problems among youth, especially since the COVID-19 pandemic. Trends in mental health-related emergency department (ED) visits are an important indicator of unmet outpatient mental health needs. To estimate annual trends in mental health-related ED visits among US children, adolescents, and young adults between 2011 and 2020. Data from 2011 to 2020 in the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national probability sample survey of EDs, was used to examine mental health-related visits for youths aged 6 to 24 years (unweighted = 49 515). Mental health-related ED visits included visits associated with psychiatric or substance use disorders and were identified by International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM; 2011-2015) and ICD-10-CM (2016-2020) discharge diagnosis codes or by reason-for-visit (RFV) codes. We estimated the annual proportion of mental health-related pediatric ED visits from 2011 to 2020. Subgroup analyses were performed by demographics and broad psychiatric diagnoses. Multivariable-adjusted logistic regression analyses estimated factors independently associated with mental health-related ED visits controlling for period effects. From 2011 to 2020, the weighted number of pediatric mental health-related visits increased from 4.8 million (7.7% of all pediatric ED visits) to 7.5 million (13.1% of all ED visits) with an average annual percent change of 8.0% (95% CI, 6.1%-10.1%; P < .001). Significant linearly increasing trends were seen among children, adolescents, and young adults, with the greatest increase among adolescents and across sex and race and ethnicity. While all types of mental health-related visits significantly increased, suicide-related visits demonstrated the greatest increase from 0.9% to 4.2% of all pediatric ED visits (average annual percent change, 23.1% [95% CI, 19.0%-27.5%]; P < .001). Over the last 10 years, the proportion of pediatric ED visits for mental health reasons has approximately doubled, including a 5-fold increase in suicide-related visits. These findings underscore an urgent need to improve crisis and emergency mental health service capacity for young people, especially for children experiencing suicidal symptoms.

Prediction of Suicide Attempts and Suicide-Related Events Among Adolescents Seen in Emergency Departments

Screening adolescents in emergency departments (EDs) for suicidal risk is a recommended strategy for suicide prevention. Comparing screening measures on predictive validity could guide ED clinicians in choosing a screening tool. To compare the Ask Suicide-Screening Questions (ASQ) instrument with the Computerized Adaptive Screen for Suicidal Youth (CASSY) instrument for the prediction of suicidal behavior among adolescents seen in EDs, across demographic and clinical strata. The Emergency Department Study for Teens at Risk for Suicide is a prospective, random-series, multicenter cohort study that recruited adolescents, oversampled for those with psychiatric symptoms, who presented to the ED from July 24, 2017, through October 29, 2018, with a 3-month follow-up to assess the occurrence of suicidal behavior. The study included 14 pediatric ED members of the Pediatric Emergency Care Applied Research Network and 1 Indian Health Service ED. Statistical analysis was performed from May 2021 through January 2023. This study used a prediction model to assess outcomes. The primary outcome was suicide attempt (SA), and the secondary outcome was suicide-related visits to the ED or hospital within 3 months of baseline; both were assessed by an interviewer blinded to baseline information. The ASQ is a 4-item questionnaire that surveys suicidal ideation and lifetime SAs. A positive response or nonresponse on any item indicates suicidal risk. The CASSY is a computerized adaptive screening tool that always includes 3 ASQ items and a mean of 8 additional items. The CASSY's continuous outcome is the predicted probability of an SA. Of 6513 adolescents available, 4050 were enrolled, 3965 completed baseline assessments, and 2740 (1705 girls [62.2%]; mean [SD] age at enrollment, 15.0 [1.7] years; 469 Black participants [17.1%], 678 Hispanic participants [24.7%], and 1618 White participants [59.1%]) completed both screenings and follow-ups. The ASQ and the CASSY showed a similar sensitivity (0.951 [95% CI, 0.918-0.984] vs 0.945 [95% CI, 0.910-0.980]), specificity (0.588 [95% CI, 0.569-0.607] vs 0.643 [95% CI, 0.625-0.662]), positive predictive value (0.127 [95% CI, 0.109-0.146] vs 0.144 [95% CI, 0.123-0.165]), and negative predictive value (both 0.995 [95% CI, 0.991-0.998], respectively). Area under the receiver operating characteristic curve findings were similar among patients with physical symptoms (ASQ, 0.88 [95% CI, 0.81-0.95] vs CASSY, 0.94 [95% CI, 0.91-0.96]). Among patients with psychiatric symptoms, the CASSY performed better than the ASQ (0.72 [95% CI, 0.68-0.77] vs 0.57 [95% CI, 0.55-0.59], respectively). This study suggests that both the ASQ and the CASSY are appropriate for universal screening of patients in pediatric EDs. For the small subset of patients with psychiatric symptoms, the CASSY shows greater predictive validity.

Temporal and spatial trends in suicide-related visits before and during the COVID-19 pandemic in the US, 2018–2021

BackgroundCOVID-19 disproportionately impacted mental health in disadvantaged populations and areas. However, disparities in long-term changes in suicide-related visits across the US are unclear. This retrospective study aims to characterize temporal and spatial changes in suicide-related visits in healthcare settings from 2018 to 2021 in the U.S. MethodsWe use electronic health records for 21,860,370 patients from Healthjump through the COVID-19 Research Database Consortium. Healthjump harmonizes EHR data from over 55 national databases across the US. Suicide ideation and suicide attempts between January 1, 2018 and December 12, 2021 were identified by the diagnosis codes in 6 periods in 2021 compared with the same periods in 2018–2020. ResultsThere was 30,019 suicidal ideation, and 7392 suicide attempt visits from January 2018 to November 2021. 15–20-year-olds were the most represented age group at 6302 suicide ideation visits (21.0 % of suicide ideation visits) and 1326 suicide attempt visits (17.9 % of suicide attempt visits), followed by suicide-related visits among 60+ years old. Compared with pre-pandemic periods, youth aged 15–20, females, White, non-Hispanic, and English speakers had increased suicide-related visits, especially suicidal ideation (P < 0.05). Suicide attempts with non-medical substances increased to 28.0 % in the first 6 months of the pandemic in 2020, compared with the prior year (21.5 %). COVID-19 patients had increased suicidal ideation in 2020. LimitationsThe EHR data is not nationally representative. ConclusionsThis study found significant and disproportionate increases in suicide related visits over the COVID-19 stages. To prevent the next storms of suicides, future interventions shall accommodate needs among vulnerable groups during and after periods of crisis.

Using the electronic health record to identify suicide risk factors in an Alaska Native Health System.

Suicide rates are higher in some Alaska Native and American Indian communities than the general U.S. population. Screening for suicide risk typically requires self-report, but many people may not engage with conventional screening because of distrust or are reluctant to disclose thoughts of suicide. Resource-sensitive methods of detecting suicide risk are needed. This study identifies routinely collected electronic health record data to identify demographic, clinical, and utilization factors associated with suicide-related visits in a tribal health care system. In this retrospective, case-control study, cases were defined as any person with a suicide-related visit from 2012 to 2015. Cases and controls were matched by age, sex, and urban/rural residence. We used conditional logistic regression to estimate odds ratios, which were interpreted as prevalence ratios (PR) based on the rare outcome assumption. The dataset included 314 cases and 1,169 controls. In the year before the index visit, cases had higher prevalence of poisoning or overdose (PR = 13.4, 95% confidence interval [CI] [3.5, 51.7]), emergency department and urgent care visits (PR = 15.8, 95% CI [6.6, 38.1]), and hospitalizations (PR = 4.5, 95% CI [3.0, 6.8]). Electronic health records can be used to identify factors that are significantly associated with suicide risk among those who may not be flagged by screening. Risk detection through electronic health record assessment might increase clinical workload in the short term, but this change would be offset by downstream prevention of suicide-related events. Such efforts could improve suicide risk detection and help to improve suicide-related health disparities in Alaska Native and American Indian populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

177 Disparities in Admission or Transfer for Inpatient Treatment after Emergency Mental Health Visits

While it is widely recognized that disparities exist in access to mental health (MH) care, the emergency department (ED) should serve as the safety net where all patients can access necessary care. We examine whether there are disparities based on patient race/ethnicity and insurance status in disposition to inpatient settings (admission or transfer) for adolescents and young adults with MH ED visits. We perform multivariate regression analysis of all MH ED visits from 2010 to 2014 reported to the Healthcare Cost and Utilization Project’s State emergency department and State Inpatient Discharge Databases for Arizona, Florida, New York, New Jersey, North Carolina, Maryland, Nevada, Kentucky, Rhode Island, and Iowa for 10-29 year olds. MH ED visits were defined as visits with a primary MH or substance abuse diagnosis or a secondary or tertiary diagnosis of suicidal ideation or attempt. We examine the probability that a MH ED visit results in an admission or transfer for further treatment and report predicted probabilities by primary payer and race/ethnicity. Regressions also control for age, sex, year, hospital location, and median income of the patient’s home address. We also perform diagnosis-specific regressions for encounters related to suicide, serious mental illness, substance use, or alcohol use. We report comparisons of predicted probabilities using Bonferroni-corrected critical values. 2.6 million MH ED visits were analyzed. For MH ED visits, the probability of admission or transfer for MH ED visits varied by the patient’s insurance and race/ethnicity (see Table). When all MH ED visits were analyzed, significantly more visits by privately insured (33.1%) than self-pay patients (25.8%) resulted in an inpatient disposition (p<0.01). Disposition after MH ED visits also varied by patient race/ethnicity. A significantly higher proportion of MH ED visits by white patients (34.0%) than black (30.8%, p<0.01), Native American (30.7%, p<0.01) or Hispanic (30.4%, p<0.01) patients resulted in admission or transfer. Differences in disposition were seen for all MH disorders analyzed, including for suicide-related visits. When compared with suicide-related visits by whites, a significantly smaller proportion of suicide-related visits by blacks, Hispanics and Native Americans resulted in admission or transfer (p<0.01 for all comparisons). Suicide-related visits by uninsured patients were significantly less likely than those by patients with private insurance, Medicaid or Medicare to result in admission or transfer (p<0.01 for all comparisons). We demonstrate sizeable disparities in disposition to inpatient settings after MH ED visits based on patient race/ethnicity and insurance status. Psychiatric inpatient beds are limited and socioeconomic disparities in access to this resource are concerning, particularly in ED patients who may have limited access to outpatient psychiatric care. Future research should focus on identifying and mitigating the underlying causes of these disparities.TablePredicted probabilities of ED disposition of admission or transfer.All Mental Health % (95% CI)Suicide-Related % (95% CI)Serious Mental Illness % (95% CI)Alcohol Use % (95% CI)Substance Use % (95% CI)PayerPrivate Insurance33.1 (33.0-33.2)66.4 (66.2-66.7)58.3 (58.0-58.6)7.2 (7.0-7.4)22.8 (22.5-23.0)Medicare36.5 (36.3-36.8)70.9 (70.2-71.6)58.7 (58.2-59.3)11.7 (10.9-12.6)25.9 (24.8-26.9)Medicaid35.7 (35.6-35.8)67.9 (67.7-68.1)58.1 (57.9-58.3)14.6 (14.3-14.9)25.5 (25.2-25.7)Self-Pay25.8 (25.7-25.9)55.2 (54.9-55.5)45.1 (44.7-45.4)5.4 (5.3-5.5)15.3 (15.1-15.6)Race/EthnicityWhite34.0 (33.9-34.0)65.8 (65.6-66.0)57.0 (56.7-57.2)9.5 (9.4-9.7)22.8 (22.6-23.0)Black30.8 (30.7-30.9)62.4 (62.0-62.7)54.6 (54.4-54.9)6.1 (6.0-6.3)15.2 (14.8-15.6)Hispanic30.4 (30.2-30.5)63.2 (62.8-63.6)54.7 (54.4-55.1)7.1 (6.9-7.3)18.8 (18.4-19.3)Asian33.5 (33.1-33.9)67.2 (66.1-68.2)61.6 (60.6-62.6)5.3 (4.7-6.0)19.1 (17.6-20.6)Native American30.7 (30.2-31.3)60.6 (59.3-62.0)57.5 (55.5-59.5)6.1 (5.6-6.5)21.2 (19.4-22.9) Open table in a new tab

Which Chart Elements Accurately Identify Emergency Department Visits for Suicidal Ideation or Behavior?

In an emergency department (ED) sample, we investigated the concordance between identification of suicide-related visits through standardized comprehensive chart review versus a subset of 3 specific chart elements: ICD-9-CM codes, free-text presenting complaints, and free-text physician discharge diagnoses. The method for this study was review of medical records for adults (≥18 years) at 8 EDs across the United States. A total of 3,776 charts were reviewed. A combination of the 3 chart elements (ICD-9-CM, presenting complaints, and discharge diagnoses) provided the most robust data with 85% sensitivity, 96% specificity, 92% PPV, and 92% NPV. These findings highlight the use of key discrete fields in the medical record that can be extracted to facilitate identification of whether an ED visit was suicide-related.

Trends in Psychiatric Emergency Department Visits Among Youth and Young Adults in the US.

Visits to the emergency department (ED) for psychiatric purposes are an indicator of chronic and acute unmet mental health needs. In the current study, we examined if psychiatric ED visits among individuals 6 to 24 years of age are increasing nationwide. ED data came from the 2011-2015 National Hospital Ambulatory Medical Care Survey, a national survey of ED visits across the United States. Psychiatric ED visits were identified by using the International Classification of Diseases, Ninth Revision and reason-for-visit codes. Survey-weighted logistic regression analyses were employed to examine trends in as well as correlates of psychiatric ED visits. Data from the US Census Bureau were used to examine population rates. Between 2011 and 2015, there was a 28% overall increase (from 31.3 to 40.2) in psychiatric ED visits per 1000 youth in the United States. The largest increases in psychiatric ED visits per 1000 US youth were observed among adolescents (54%) and African American (53%) and Hispanic patients (91%). A large increase in suicide-related visits (by 2.5-fold) was observed among adolescents (4.6-11.7 visits per 1000 US youth). Although psychiatric ED visits were long (51% were ≥3 hours in length), few (16%) patients were seen by a mental health professional during their visit. Visits to the ED for psychiatric purposes among youth are rising across the United States. Psychiatric expertise and effective mental health treatment options, particular those used to address the rising suicide epidemic among adolescents, are needed in the ED.

Detecting Suicide-Related Emergency Department Visits Among Adults Using the District of Columbia Syndromic Surveillance System.

Limited studies have examined the usefulness of syndromic surveillance to monitor emergency department (ED) visits involving suicidal ideation or attempt. The objectives of this study were to (1) examine whether syndromic surveillance of chief complaint data can detect suicide-related ED visits among adults and (2) assess the added value of using hospital ED data on discharge diagnoses to detect suicide-related visits. The study data came from the District of Columbia electronic syndromic surveillance system, which provides daily information on ED visits at 8 hospitals in Washington, DC. We detected suicide-related visits by searching for terms in the chief complaints and discharge diagnoses of 248 939 ED visits for which data were available for October 1, 2015, to September 30, 2016. We examined whether detection of suicide-related visits according to chief complaint data, discharge diagnosis data, or both varied by patient sex, age, or hospital. The syndromic surveillance system detected 1540 suicide-related ED visits, 950 (62%) of which were detected through chief complaint data and 590 (38%) from discharge diagnosis data. The source of detection for suicide-related ED visits did not vary by patient sex or age. However, whether the suicide-related terms were mentioned in the chief complaint or discharge diagnosis differed across hospitals. ED syndromic surveillance systems based on chief complaint data alone would underestimate the number of suicide-related ED visits. Incorporating the discharge diagnosis into the case definition could help improve detection.

Intervening to prevent suicide

Suicidal behaviour is a pervasive, persistent, and pressing public health problem, resulting in millions of suicide-related visits to emergency departments worldwide each year. Emergency department presentation rates in psychiatric and suicidal populations continue to increase.1 Substantial evidence shows that a history of suicide attempt is the most salient risk factor for further suicide attempts and for death by suicide.2,3 About half of those who die by suicide have made at least one previous suicide attempt, and among those who have made suicide attempts, an estimated one in 25 will die by suicide in the subsequent 5 years.... Language: en

Youth suicide-related visits in an emergency department serving rural counties: Implications for means restriction

A large proportion of suicide attempts result in injuries requiring medical attention, but little is known about youth presenting to rural emergency departments (EDs) for suicide-related behavior. We conducted a chart review of youth receiving mental health (MH) evaluations during 1994 in an ED serving rural counties. Forty percent of the these visits were for suicide-related events. These youth were more likely to be older. female and white than youth receiving MH evaluations for reasons not related to suicide. No differences were found on recent substance use, non-suicidal aggression, or MH service contact when comparing suicidal to non-suicidal youth. Youth receiving MH evaluations were homogenous with respect to suicide risk factors. Chart reviews provided no evidence that means restriction education was provided. We discuss broader implications of these findings for the role of means restriction in EDs.

Youth suicide-related visits in an emergency department serving rural counties: Implications for means restriction

A large proportion of suicide attempts result in injuries requiring medical attention, but little is known about youth presenting to rural emergency departments (EDs) for suicide-related behavior. We conducted a chart review of youth receiving mental health (MH) evaluations during 1994 in an ED serving rural counties. Forty percent of the these visits were for suicide-related events. These youth were more likely to be older, female and white than youth receiving MH evaluations for reasons not related to suicide. No differences were found on recent substance use, non-suicidal aggression, or MH service contact when comparing suicidal to non-suicidal youth. Youth receiving MH evaluations were homogenous with respect to suicide risk factors. Chart reviews provided no evidence that means restriction education was provided. We discuss broader implications of these findings for the role of means restriction in EDs.