Predicting 3‐month risk for adolescent suicide attempts among pediatric emergency department patients

Abstract

Background The incidence of adolescent suicide is rising in the United States, yet we have limited information regarding short‐term prediction of suicide attempts. Our aim was to identify predictors of suicide attempts within 3‐months of an emergency department (ED) visit. Methods Adolescents, ages 12–17, seeking health care at 13 pediatric EDs (Pediatric Emergency Care Applied Research Network) and one Indian Health Service Hospital in the United States were consecutively recruited. Among 10,664 approached patients, 6,448 (60%) were enrolled and completed a suicide risk survey. A subset of participants (n = 2,897) was assigned to a 3‐month telephone follow‐up, and 2,104 participants completed this follow‐up (73% retention). Our primary outcome was a suicide attempt between the ED visit and 3‐month follow‐up. Results One hundred four adolescents (4.9%) made a suicide attempt between enrollment and 3‐month follow‐up. A large number of baseline predictors of suicide attempt were identified in bivariate analyses. The final multivariable model for the full sample included the presence of suicidal ideation during the past week, lifetime severity of suicidal ideation, lifetime history of suicidal behavior, and school connectedness. For the subgroup of adolescents who did not report recent suicidal ideation at baseline, the final model included only lifetime severity of suicidal ideation and social connectedness. Among males, the final model included only lifetime severity of suicidal ideation and past week suicidal ideation. For females, the final model included past week suicidal ideation, lifetime severity of suicidal ideation, number of past‐year nonsuicidal self‐injury (NSSI) incidents, and social connectedness. Conclusions Results indicate that the key risk factors for adolescent suicide attempts differ for subgroups of adolescents defined by sex and whether or not they report recent suicidal thoughts. Results also point to the importance of school and social connectedness as protective factors against suicide attempts.

Practitioner Review: Treatment for suicidal and self‐harming adolescents – advances in suicide prevention care

“…Accumulating data indicate that youths with self‐harm histories are at increased risk of suicide deaths and increased risk of death by other unnatural causes, such as overdoses (Hawton et al., ; Morgan, Byrne, Boylan, McLearie, & Fitzpatrick, ). These results in conjunction with evidence reported in this issue that health risk behaviors such as substance abuse are associated with increased risk of SAs (Barzilay et al., ; King, Grupp‐Phelan et al., ) underscore the importance of clinical evaluation and monitoring of substance use in youths with suicide/self‐harm risk.…”

“…History of maltreatment and exposure to traumatic stress (e.g., abuse, peer victimization) have been shown to be associated with increased risk of SAs in two studies in this issue (King, Grupp‐Phelan et al., ; Zelazny et al., ) and with self‐harm in Russell et al. ().…”

“…Identification and activation of parents and trusted adults who can function like ‘protective seatbelts’ and keep youths safe during moments when they experience suicidal/self‐harm urges may enhance the outcomes of care regardless of the type of treatment delivered. (Asarnow et al., ; King, Grupp‐Phelan et al., ; Wyman et al., ). Most youths spend a great deal of time in school, the impact of the school environment cannot be ignored as patterns within schools are associated with differences in the risk of SI and SAs. Practitioners in both school and mental health settings should consider the school environment in their treatment plans and work to enhance protective influences within the school.…”

Adolescents’ Engagement with Crisis Hotline Risk‐management Services: A Report from the Emergency Department Screen for Teen Suicide Risk (ED‐STARS) Study

“…At baseline, adolescents completed a self‐report suicide risk survey and caregivers (or legal guardians) completed a brief survey about themselves and their adolescent (King et al., unpublished paper; National Institute of Mental Health, ). Adolescents identified for follow‐up (enriched for higher risk) participated in 3‐month computerized telephone follow‐up interviews.…”

Editorial: Suicide and self‐harm: advancing from science to preventing deaths

“…Miller and colleagues () emphasize the value of understanding patterns of stresses within individuals, an approach that may enhance identification of time‐points when intervention might prevent self‐harm. Papers led by Zelazny (), Russell (), and King et al () confirm that the history of maltreatment is a robust risk factor for self‐harm. Barzilay et al.…”