Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #117179

Cameron S. Crandall, MD¹, Jonathon LaValley, BS¹, Roberto Aguero, MS¹, and Lynne Fullerton-Gleason, PhD². (1) Department of Emergency Medicine, University of New Mexico, Center for Injury Prevention Research and Education, ACC 4-W, Albuquerque, NM 87131-5246, (2) Center for Injury Prevention, Research, and Education, University of New Mexico, Department of Emergency Medicine, ACC 4-West, Albuquerque, NM 87131-5246, 505-272-6183, lfullerton@salud.unm.edu

The suicide rate for emergency department (ED) patients seen for suicidal behavior who are subsequently discharged from the ED is unknown. We sought to determine if suicide mortality for a cohort of patients seen and subsequently discharged from the ED for a suicide-related complaint were higher than comparison groups. Nonconcurrent prospective cohort data from a university-affiliated urban ED (2/94–11/04) were probabilistically linked to state mortality records. Exposure classification was determined from billing diagnoses, E-codes (E950–E959), and text searching of the ED tracking system data for ‘suicide,' ‘overdose' and variants. All ED patients (10+ years) with visits for suicide attempt/ideation, self-harm, or overdose (‘exposed') were compared to patients without these visits (‘unexposed'). The principal outcome was suicide death. Suicide mortality rates were calculated using person-year (py) analyses. Relative rates (RR) and 95% confidence intervals (CI) were calculated from Cox Proportional Hazards models. Among the 218,304 patients, the average follow-up length was 6.0 years; there were 449 suicide deaths (incidence rate (IR): 34.4 per 100,000 py). Males (IR: 53.6) had a higher rate than females (IR: 14.6) (RR: 3.7; CI: 2.9, 4.6). A single ED visit for overdose (RR: 6.2; CI: 4.7–8.4), suicidal ideation (RR: 7.0; CI: 5.3–9.4), or self-harm (RR: 12.2; CI: 9.1–16.4) was strongly associated with increased suicide risk relative to other patients. The suicide rate among ED patients is higher than population-based estimates. Rates among patients with suicidal ideation, overdose or self-harm are especially high, supporting policies that mandate psychiatric interventions in all cases.

Learning Objectives:

• 1. Describe the rate of suicide following suicidal behavior among patients seen and discharged from the emergency department.
• 2. Identify emergency department populations at highest risk of suicide based upon demographic and visit characteristics.
• 3. Recognize the need for mandatory psychiatric evaluation following suicide attempt.

Keywords: Suicide, Emergency Department/Room

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation