Medical emergency department visits can indicate increased suicide risk among teens and young adults

Identifying patterns in medical encounters prior to self-directed violence events can help shape screening and prevention strategies, according to a new study in the American Journal of Preventive Medicine


Ann Arbor, December 17, 2018

A new study published in the American Journal of Preventive Medicine provides detailed insights on the increased risk of self-directed violence that patients aged 15-29 years visiting the emergency department (ED) for medical complaints subsequently experience. This underscores the importance of EDs in suicide prevention. The broad number of physical health conditions associated with an increased risk of self-directed violence may serve to support expanded or broader screening among teens and young adults.

Suicide is the second leading cause of death for youth, with mental disorders and substance abuse as the two leading risk factors. Approximately 40 percent of suicide decedents aged 16 and older visit EDs in the year prior to their deaths; 60 percent of them receive medical diagnoses other than mental health or substance abuse.

“Young people presenting to the ED for certain medical conditions are at an increased risk of subsequent self-directed violence,” explained lead investigator Jing Wang, MD, MPH, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA, in the study’s findings. “An awareness of these medical encounters may help guide screening efforts for suicide prevention in clinical settings.”

This study addresses important gaps in prior research by identifying the medical reasons triggering youth ED visits that are associated with higher risk of subsequent suicidal behavior. Using 2011-2013 data from six states (Florida, New York, Nebraska, Vermont, Iowa, and Massachusetts) from databases sponsored by the Agency for Healthcare Research and Quality, investigators followed more than two million teens and young adults (aged 15-29) who visited EDs for medical reasons during 2012-2013. Of that group, nearly 8,500 subsequently engaged in self-directed violence within six months of the initial visit; anyone who exhibited suicidal behavior in 2011 was excluded from the study.

Teens and young adults who presented with diagnoses of epilepsy or seizures, or visited two or more times for various types of pain, syncope (fainting), or vomiting had a 3-9 fold increased risk of suicidal behavior in the following six months. Individuals who visited three or more times for dental complaints were also found to be more likely to engage in subsequent self-directed violence. ED visitors in the group who received diagnoses of minor infections served as a reference group.

The findings also showed that half of the self-directed violence events occurred within 42 days of the initial ED visit. Identification of the heightened risk for suicide following visits for these medical conditions provides ED clinicians with a critical window of opportunity for detection, assessment, and intervention. The broad number of physical health conditions associated with an increased risk of subsequent suicidal behavior may help inform and support expanded screening and suicide prevention strategies in EDs.

A limitation of the study is that about 70 percent of people who engage in self-directed violence do not seek medical assistance.

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Notes for editors
The article is “Self-Directed Violence After Medical Emergency Department Visits Among Youth,” by Jing Wang, MD, MPH, Hui Xie, PhD, Kristin M. Holland, PhD, MPH, Steven A. Sumner, MD, MSc, Alexandra B. Balaji, PhD, Corinne F. David-Ferdon, PhD, and Alexander E. Crosby, MD, MPH (https://doi.org/10.1016/j.amepre.2018.09.014). It appears in advance of the American Journal of Preventive Medicine, volume 56, issue 2 (February 2019) published by Elsevier.

Full text of this article is available to credentialed journalists upon request; contact Jillian B. Morgan at +1 734 936 1590 or ajpmmedia@elsevier.com. Journalists who wish to interview the authors should contact CDC Media Relations at +1 404 639 3286 or media@cdc.gov.

About the American Journal of Preventive Medicine
The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials. www.ajpmonline.org

About Elsevier
Elsevier is a global information analytics business that helps institutions and professionals advance healthcare, open science and improve performance for the benefit of humanity. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support and professional education, including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, more than 38,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX Group, a global provider of information and analytics for professionals and business customers across industries. www.elsevier.com

Media contact
Jillian B. Morgan, MPH, Managing Editor
AJPM
+1 734 936 1590
ajpmmedia@elsevier.com