Results underscore need for screening of risk
A new study published last month in JAMA Network Open found that people who presented to California emergency departments with deliberate self-harm had a suicide rate in the following year 56.8 times higher than those of demographically similar Californians.
People who presented with suicidal ideation had suicide rates 31.4 times higher than those of demographically similar Californians in the year after discharge. These findings reinforce the importance of universal screening for suicide risk in emergency departments and the need for follow-up care.
The study was funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health.
More than 500,000 people present to emergency departments each year with deliberate self-harm or suicidal ideation — both major risk factors for suicide. However, little is known about what happens to these people in the year after they leave emergency care.
“Until now, we have had very little information on suicide risk among patients after they leave the emergency department because data that link emergency records to death records are rare in the United States. Understanding the characteristics and outcomes of people with suicide risk who visit emergency departments is important for helping researchers and practitioners improve treatment and outcomes,” said lead author Sidra Goldman-Mellor, Ph.D., an assistant professor of public health at the University of California, Merced.
The researchers divided individuals presenting to the emergency department into three groups: people with deliberate self-harm with or without co-occurring suicidal ideation (85,507 patients), people presenting with suicidal ideation but without deliberate self-harm (67,379 patients), and people without either self-harm or suicidal ideation, called “reference” patients (497,760 patients).
The researchers found that the probability of suicide in the first year after discharge from an emergency department was highest — almost 57 times that of demographically similar Californians overall — for people who had presented with deliberate self-harm. For those who presented with suicidal ideation, the suicide rate was approximately 31 times higher than among Californians overall. The suicide rate for the reference patients was the lowest amongst the studied groups, but still double the suicide rate among Californians overall.
“We think our findings will be useful for guiding intervention and healthcare quality improvement efforts,” said Goldman-Mellor. “Our results also highlight the fact that patients with suicidal ideation or self-harming behaviors are at high risk not only for death by suicide, but also for death by accidents, homicide, and natural causes. We think this shows the importance of addressing the full spectrum of their health and social needs in follow-up care.”