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Suicide risk increases following hospital discharge for injury

Adolescents discharged from the hospital after adversity-related injury, including self-inflicted, drug- or alcohol-related, or violent injury, had significantly higher risk for suicide 10 years post-discharge, except females with violent injury.

“Our findings show the enormous value of using routinely collected patient data to spot opportunities for the NHS to intervene to reduce risk of harm for vulnerable patients, many of whom come back to the hospital time and again,” study researcher Ruth Gilbert, MD, of UCL Great Ormond Street Institute of Child Health, London, said in a press release.

To determine cause of death up to 10 years after hospital admission for self-inflicted, drug- or alcohol-related, or violent injury during adolescence, researchers conducted a retrospective, nationwide cohort study of adolescents, aged 10 to 19 years, admitted as an emergency for adversity-related or accident-related injury between April 1997 and March 2012. Analysis included 333,009 adolescents admitted with adversity-related injury and 649,818 admitted with accident-related injury.

Overall, 30.8% of adolescents admitted with adversity-related injury and 60.2% admitted with accident-related injury died in 10 years after discharge.

Male (adjusted subHR = 3.15; 95% CI, 2.73-3.63) and female adolescents (adjusted sub-HR = 4.54; 95% CI, 3.25-6.36) discharged after adversity-related injury had higher risk for suicide and drug-related or alcohol-related death (adjusted subHR= 3.53; 95% CI, 3.04-4.09 for males; 4.71; 95% CI, 3.28-6.76 for females), compared with those discharged after accident-related injury.

Researchers found insufficient evidence that females discharged after adversity-related injury had increased risk for accidental death compared with those discharged after accident-related injury (adjusted subHR = 1.21; 95% CI, 0.9-1.63). However, there was evidence that this risk was higher for males (adjusted subHR = 1.26; 95% CI, 1.09-1.47).

Compared with accident-related injury, risk for suicide was higher following self-inflicted injury (adjusted subHR= 5.11; 95% CI, 3.61-7.23 for females; 6.2; 95% CI, 5.27-7.3 for males), drug-related or alcohol-related injury (adjusted subHR = 4.55; 95% CI, 3.23-6.39 for females; 4.51 95% CI, 3.89-5.24 for males), and violent injury in males (adjusted subHR = 1.43; 95% CI, 1.15-1.78).

However, increased suicide risk in females with violent injury was not significantly higher.

Risk for suicide or drug- and alcohol-related death increased similarly following each type of index injury.

“Given that risks remain high for at least a decade, crisis presentations in adolescents should be seen as more than a passing phase. Immediate health service responses alone will be insufficient,” George Patton, PhD, and Rohan Borschmann, PhD, of Royal Children’s Hospital, Parkville, Australia, wrote in an accompanying editorial. “There is also a need to consider the social contexts that will support an adolescent’s ongoing emotional development and minimize hazards from social adversity and substance abuse. This social scaffold will necessarily extend beyond the health service system to promote protective and enabling relationships with families, schools, communities, and peers. It will require a coordination of policy and practice, a process that should now be the focus of further research.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.