Suicide attempt, self-harm in ED patients pose risks in year after discharge
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ED patients with suicide attempts or self-harm had a high risk for suicide in the year after discharge, according to study results published in Journal of Clinical Psychiatry.
“In evaluating suicide risk, it would be helpful to understand the effects of recent events on current risk,” Mark Olfson, MD, MPH, of the department of psychiatry at Vagelos College of Physicians and Surgeons, Columbia University, New York, and colleagues wrote. “It is not known, for example, whether among mental health ED patients with suicidal ideation, those with recent prior ED visits with suicidal ideation are at increased suicide risk. Large cohort studies are needed to connect recent ED visit patterns to future suicide risk.”
The investigators aimed to examine risk factors and the suicide rate in the year after discharge from mental health ED visits among adults with suicide attempts, suicidal ideation or neither. Using national cohorts of patients with mental health ED visits, they analyzed data of 55,323 patients with suicide attempts or self-harm, 435,464 patients with suicidal ideation and 9,144,807 patients with other mental health visits via 2008 to 2012 Medicaid data. All patients were followed for suicide for 1 year after discharge. Olfson and colleagues determined suicide rates per 100,000 person-years using National Death Index data and estimated suicide rate ratios using Poisson regression models, adjusted for age, sex and race/ethnicity. Further, they used National Vital Statistics System data to estimate suicide standardized mortality ratios (SMRs).
Results showed 325.4 suicide rates per 100,000 person-years for suicide attempt or self-harm visits (RR = 5.51; 95% CI, 4.64-6.55) 156.6 for suicidal ideation visits (RR = 2.59; 95% CI, 2.34-2.97) and 57 for the other mental health ED visits. Olfson and colleagues reported SMRs of 18.2 (95% CI, 13–23.4) for patients with suicide attempt or self-harm, 10.6 (95% CI, 9–12.2) for patients with suicidal ideation and 3.2 (95% CI, 3.1–3.4) for patients with other ED mental health, compared with the expected suicide general population rates. Among patients with suicide attempt ED visits in the 180 days prior to the index mental health ED visit, the researchers reported suicide rates per 100,000 person-years of 687.2 (95% CI, 396.5–978) for attempt or self-harm visits, 397.4 (95% CI, 230.6–564.3) for ideation visits and 328.4 (95% CI, 241.5–415.4) for other mental health visits.
“ED physicians should bear in mind that suicide risk following ED discharge is substantially higher for mental health patients with current or recent ED visits for suicide attempts or self-harm events,” Olfson and colleagues wrote. “Even among ED mental health patients without current suicidal symptoms, a recent suicide attempt or self-harm event markedly increased suicide risk. Learning which ED mental health patients pose high short-term suicide risk will hopefully improve clinical judgments concerning the appropriate level of follow-up care.”