Department of Surgery,Johns Hopkins Surgery Center for Outcomes Research,Johns Hopkins University School of Medicine,Baltimore,Maryland,USA.
International Center for Spinal Cord Injury,Kennedy Krieger Institute,Baltimore,Maryland,USA.
Epidemiol Psychiatr Sci. 2018 Feb;27(1):94-102. doi: 10.1017/S2045796016000871. Epub 2016 Nov 17.
To characterise and identify nationwide trends in suicide-related emergency department (ED) visits in the USA from 2006 to 2013.
We used data from the Nationwide Emergency Department Sample (NEDS) from 2006 to 2013. E-codes were used to identify ED visits related to suicide attempts and self-inflicted injury. Visits were characterised by factors such as age, sex, US census region, calendar month, as well as injury severity and mechanism. Injury severity and mechanism were compared between age groups and sex by chi-square tests and Wilcoxon rank-sum tests. Population-based rates were computed using US Census data.
Between 2006 and 2013, a total of 3 567 084 suicide attempt-related ED visits were reported. The total number of visits was stable between 2006 and 2013, with a population-based rate ranging from 163.1 to 173.8 per 100 000 annually. The frequency of these visits peaks during ages 15-19 and plateaus during ages 35-45, with a mean age at presentation of 33.2 years. More visits were by females (57.4%) than by males (42.6%); however, the age patterns for males and females were similar. Visits peaked in late spring (8.9% of all visits occurred in May), with a smaller peak in the fall. The most common mechanism of injury was poisoning (66.5%), followed by cutting and piercing (22.1%). Males were 1.6 times more likely than females to use violent methods to attempt suicide (OR = 1.64; 95% CI = 1.60-1.68; p < 0.001). The vast majority of patients (82.7%) had a concurrent mental disorder. Mood disorders were the most common (42.1%), followed by substance-related disorders (12.1%), alcohol-related disorders (8.9%) and anxiety disorders (6.4%).
The annual incidence of ED visits for attempted suicide and self-inflicted injury in the NEDS is comparable with figures previously reported from other national databases. We highlighted the value of the NEDS in allowing us to look in depth at age, sex, seasonal and mechanism patterns. Furthermore, using this large national database, we confirmed results from previous smaller studies, including a higher incidence of suicide attempts among women and individuals aged 15-19 years, a large seasonal peak in suicide attempts in the spring, a predominance of poisoning as the mechanism of injury for suicide attempts and a greater use of violent mechanisms in men, suggesting possible avenues for further research into strategies for prevention.
描述并确定 2006 年至 2013 年美国全国范围内与自杀相关的急诊科就诊的趋势。
我们使用了 2006 年至 2013 年全国急诊科样本（NEDS）的数据。使用 E 码来识别与自杀企图和自我伤害有关的急诊科就诊。就诊特征包括年龄、性别、美国人口普查区域、日历月以及伤害严重程度和机制等因素。通过卡方检验和威尔科克森秩和检验比较了不同年龄组和性别的伤害严重程度和机制。使用美国人口普查数据计算了基于人群的发生率。
在 2006 年至 2013 年期间，共报告了 3567084 例与自杀企图相关的急诊科就诊。就诊总数在 2006 年至 2013 年期间保持稳定，每年每 100000 人中有 163.1 至 173.8 例就诊。这些就诊的频率在 15-19 岁之间达到峰值，在 35-45 岁之间达到平台期，就诊者的平均年龄为 33.2 岁。女性就诊者（57.4%）多于男性就诊者（42.6%）；然而，男性和女性的年龄模式相似。就诊高峰出现在春末（所有就诊中有 8.9%发生在 5 月），秋季有一个较小的高峰。最常见的伤害机制是中毒（66.5%），其次是切割和刺穿（22.1%）。男性自杀企图时使用暴力方法的可能性是女性的 1.6 倍（OR=1.64；95%CI=1.60-1.68；p<0.001）。绝大多数患者（82.7%）同时患有精神障碍。情绪障碍最为常见（42.1%），其次是物质相关障碍（12.1%）、酒精相关障碍（8.9%）和焦虑障碍（6.4%）。
NEDS 中报告的与自杀企图和自我伤害相关的急诊科就诊的年发生率与之前其他国家数据库报告的数字相当。我们强调了 NEDS 的价值，它使我们能够深入研究年龄、性别、季节性和机制模式。此外，使用这个大型国家数据库，我们证实了之前较小研究的结果，包括女性和 15-19 岁人群自杀企图发生率较高、春季自杀企图的季节性高峰较大、中毒是自杀企图的主要伤害机制以及男性更倾向于使用暴力手段，这为进一步研究预防策略提供了可能的途径。
