April 11, 2019
2 min read

ED visits double among US teens considering suicide

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Photo of Brett Burstein
Brett S. Burstein

Researchers have identified a surge in the number of American children presenting to EDs who have considered or attempted suicide. They estimated that the number of ED visits nearly doubled between 2007 and 2015.

Brett S. Burstein, MDCM, PhD, MPH, an associate investigator at the McGill University Health Center’s Research Institute, told Infectious Diseases in Children that a study published last year demonstrated a significant rise in suicidal behavior among children presenting to pediatric EDs. Burstein and colleagues suspected that “this number was just the tip of the iceberg.”

“This is a complicated issue,” he said. “While increased recognition and referrals to EDs may play a role, in our sample, less than 13% of youth were isolated for suicidal thoughts, meaning that most children are presenting following some type of gesture or attempt. More concerning is that there is an increasing burden of mental health problems among children and young adults.”

Burstein and colleagues analyzed data on ED visits collected annually by the CDC’s National Center for Health Statistics. They focused their analysis on children aged 5 to younger than 18 years with a chief complaint or discharge diagnosis of suicidal ideation or attempt between 2007 and 2015.

During the study period, 1,613 children were identified as having an ED visit for suicidal ideation or attempt, with a median age of 13 years (interquartile range [IQR] = 8-15 years). Most of these children were evaluated in nonpediatric, nonteaching hospitals.

The researchers noted that children aged 5 to younger than 11 years accounted for nearly half (43.1%) of ED presentations for suicidal ideation or attempt, but only 2.1% of these children were hospitalized.

Researchers observed that the number of children presenting to EDs with suicidal ideation or who attempted suicide nearly doubled during the study period.
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Burstein and colleagues estimated that the number of annual ED visits for suicidal ideation and attempts increased 91.2% (95% CI, 68.9%-130.3%; P for trend = .004) during the study period, from 580,000 to 1.12 million. However, they did not identify a statistically significant change in the total number of ED visits (26.9 million to 31.8 million; 18.2%; 95% CI, –5.4% to 42.2%).

As a proportion of all pediatric ED visits, suicidal ideation and attempts increased from 2.17% (95% CI, 1.82%-2.58%) to 3.5% (95% CI, 2.79%-4.39%). The researchers also observed a 79.3% (95% CI, 62.2%-137.8%; P for trend = .02) increase in ED visits for suicide attempts alone during the study period (95% CI, 62.2%-137.8%).

“A single suicide attempt is the strongest predictor of future completed suicide,” Burstein said. “Most children with suicidal behavior first present in the ED setting. Community and general EDs are not resourced to give these children the comprehensive assessments and follow-up necessary for optimal care. The growing number of these presentations means that we critically need to augment resources for community-based mental health services, ED preparedness — particularly among nonpediatric centers — and post-ED risk reduction interventions.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.