ER Visits Rise for Kids Who Consider Suicide

The annual estimated visits to EDs for suicide attempts and suicidal ideation in 2007 was 580,000 for children, which jumped to 1.12 million in 2015.

This article first appeared on Monday, April 8, 2019 in MedPage Today.

By Kristen Monaco, Staff Writer, MedPage Today.

Emergency department (ED) visits for suicide attempts and suicidal ideation doubled among U.S. children and adolescents from 2007 to 2015, researchers reported.

In a cross-sectional analysis, the annual estimated visits to EDs for suicide attempts and suicidal ideation in 2007 was 580,000 for children (median age 13 years), which jumped to 1.12 million in 2015 (92.1%, 95% CI 68.9%-130.3%; P=0.004 for trend), according to Brett Burstein, MDCM, PhD, MPH, of Montreal Children's Hospital, and colleagues.

Kids, ages 5 to 11 years, accounted for the largest proportion of those ED visits, they reported in JAMA Pediatrics:

• Ages 5 to <12: 43.1% (95% CI 39.6%-46.6%)
   
• Ages 12 to <15: 24.3% (95% CI 21.4%-27.6%)
   
• Ages 15 to <18: 32.6% (95% CI 29.5%-35.8%)

"Findings suggest a critical need to augment community mental health resources, ED physician preparedness, and post-emergency department risk reduction initiatives to decrease the burden of suicide among children," Burstein's group noted.

However, there was no statistically significant change in total ED visits during the time period at 26.9 million to 31.8 million (18.2%, 95% CI -5.4% to 42.2%, P=0.67 for trend).

Suicide attempts and suicidal ideation grew to account for a larger proportion of all ED visits for youth over this nine-year period from 2.17% to 3.50% (61% increase; P=0.001 for trend), the researchers reported.

A previous retrospective review of hospital database records also showed a doubling in the annual percentage of hospital visits for suicide ideation and suicide attempts among U.S. children from 2008 to 2015.

Drawing on data from the National Hospital Ambulatory Medical Care Survey database, the researchers looked at samples of ED visits from 300 randomly selected U.S. hospitals.

"A strength of the NHAMCS is its inclusion of hospitals other than academic centers, which are the settings for most published research, thereby giving a more complete picture of health care trends," they noted, adding that in "this broader setting, NHAMCS data suggest more at-risk young children than described among pediatric hospitals alone."

Burstein and colleagues pointed out that "no conclusions can be drawn regarding the cause for the observed increase, which is likely multifactorial."

They used multistage probability sampling to generalize the data to calculate U.S. population-level estimates.

The analysis included children, ages 5 to 18 years, who had either a chief complaint or a discharge diagnosis of a suicide attempt or suicidal ideation. The researchers cautioned that one limitation to this method was the possibility of a nonsuicidal self-harm being incorrectly coded as either a suicide attempt or suicidal ideation by a physician.

The majority of the visits were for a suicide attempt, accounting for over 87% (95% CI 84.1%-89.7%) of cases, while 12.8% of ED visits were for suicidal ideation without a suicide attempt. Looking at just suicide attempts only, ED visits rose from 540,000 in 2007 up to 960,000 in 2015 (79.3% increase, 95% CI 62.2%-137.8%, P=0.02 for trend).

Burstein told USA Today that "The majority of the patients tracked in the data did not go to specialized pediatric centers. Most EDs "are not, in general, adequately equipped to deal with this problem," he added. "They lack the resources to deal with this mental health crisis."