Suicide Risk Among Adults With Mental Health Emergency Department Visits With and Without Suicidal Symptoms

Mark Olfson, MD, MPH; Y. Nina Gao, MD, PhD; Ming Xie, MS; Sara Wiesel Cullen, PhD, MSW; Steven C. Marcus, PhD

J Clin Psychiatry 2021;82(6):20m13833

ABSTRACT

Objective: To describe risk factors and suicide rates during the year following discharge from mental health emergency department (ED) visits by adults with suicide attempts, suicidal ideation, or neither.

Methods: National cohorts of patients with mental health ED visits for suicide attempts or self-harm (n = 55,323), suicidal ideation (n = 435,464), or other mental health visits (n = 9,144,807) from 2008 to 2012 Medicaid data were followed for suicide for 1 year after discharge. Suicide rates per 100,000 person-years were determined from National Death Index data. Poisson regression models, adjusted for age, sex, and race/ethnicity, estimated suicide rate ratios (RRs). Suicide standardized mortality ratios (SMRs) were estimated from National Vital Statistics System data.

Results: Suicide rates per 100,000 person-years were 325.4 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, 2.34–2.87), and 57.0 for the other mental health ED visits (1.0, reference). Compared to expected suicide general population rates, SMRs were 18.2 (95% CI, 13.0–23.4) for suicide attempt or self-harm patients, 10.6 (95% CI, 9.0–12.2) for suicidal ideation patients, and 3.2 (95% CI, 3.1–3.4) for other ED mental health patients. Among patients with suicide attempt ED visits in the 180 days before their index mental health ED visit, suicide rates per 100,000 person-years were 687.2 (95% CI, 396.5–978.0) 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.

Conclusions: In the year following discharge, emergency department patients with suicide attempts or self-harm, especially repeated attempts, have a high risk of suicide.

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