Pagliaccio David, Kirshenbaum Jaclyn S, Keyes Katherine M, Auerbach Randy P
Department of Psychiatry, Columbia University, New York, New York.
Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York.
JAMA Netw Open. 2025 Jul 1;8(7):e2522591. doi: 10.1001/jamanetworkopen.2025.22591.
Suicide rates have increased in recent years to the third leading cause of death among youths. Children presenting to the emergency department (ED) for suicide thoughts and behaviors (STB) are at high risk for recurrent mental health (MH) concerns.
To quantify rates of STB among children presenting to EDs across the US and to identify risk factors for return ED visits for STB.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study examined electronic health records of children who presented to the ED from January 2010 to December 2020 using the State Emergency Department Database within the Healthcare Cost and Utilization Project. All ED visits were screened among children aged 8 to 12 years in 12 states with data linking patients across visits. International Classification of Disease (ICD) codes separated non-STB MH and STB-related visits. Data were analyzed from August 2024 to January 2025.
Analyses examined characteristics of visits for MH vs STB and patients returned for subsequent ED visit(s) for STB. Analyses compared visits for MH vs. STB and examined factors related to subsequent ED return visit(s) for STB. This included sociodemographic, clinical, and temporal factors derived from electronic health records.
A total of 10 131 432 ED visits were screened, and 627 517 visits (6%) among 374 118 unique patients implicated ICD codes for non-STB MH causes (534 654 visits [5%]; mean [SD] age, 10.25 [1.41] years; 189 701 female [35%]) or STB (92 863 visits [1%]; mean [SD] age, 10.87 [1.27] years; 50 679 female [55%]). MH and STB visits increased from 36 623 ED visits (5%) in 2010 to 22 443 ED visits (10%) in 2020. Compared with non-STB MH visits, patients with STB were more likely to have private insurance and reside in areas with higher income and less deprivation (via linkage to social deprivation index). There was an age-by-sex interaction (z = 48.22; P < .001); a greater percentage of STB patients were female at older ages vs younger ages. Suicide behaviors mostly implicated injury by ingestion (7121 [43%]) or sharp or blunt object (6518 [39%]). Additionally, 68 897 patients had multiple ED visits (18%), 6537 with multiple STB visits (10%); 117 377 of 187 864 return ED visits were within 3 months (62%). STB was strongly associated with ED return for STB (aOR, 9.71 [99% CI, 9.66-9.76]; z = 127.93). Return STB visits within 1-year were more common for females and patients with more MH comorbidity, longer initial visits, and without private insurance.
Suicide risk is common but remains understudied among children. Early suicide risk was associated with recurrent STB, particularly in the months following ED discharge. Understanding risk and protective factors among children can enhance ED screening, intervention, and follow-up care.
近年来，自杀率已升至青少年死亡的第三大主要原因。因自杀想法和行为（STB）前往急诊科（ED）就诊的儿童，再次出现心理健康（MH）问题的风险很高。
量化美国各地急诊科就诊儿童中的STB发生率，并确定因STB再次前往急诊科就诊的风险因素。
设计、设置和参与者：这项队列研究使用医疗保健成本与利用项目中的州急诊科数据库，检查了2010年1月至2020年12月期间前往急诊科就诊的儿童的电子健康记录。在12个州对8至12岁儿童的所有急诊科就诊进行了筛查，数据可跨就诊链接患者。国际疾病分类（ICD）代码区分了非STB MH就诊和与STB相关的就诊。数据于2024年8月至2025年1月进行分析。
分析检查了MH就诊与STB就诊的特征以及因STB再次前往急诊科就诊的患者情况。分析比较了MH就诊与STB就诊，并检查了与因STB再次前往急诊科就诊相关的因素。这包括从电子健康记录中得出的社会人口统计学、临床和时间因素。
共筛查了10131432次急诊科就诊，374118名独特患者中的627517次就诊（6%）涉及非STB MH原因的ICD代码（534654次就诊[5%]；平均[标准差]年龄，10.25[1.41]岁；189701名女性[35%]）或STB（92863次就诊[1%]；平均[标准差]年龄，10.87[1.27]岁；50679名女性[55%]）。MH和STB就诊次数从2010年的36623次急诊科就诊（5%）增加到2020年的22443次急诊科就诊（10%）。与非STB MH就诊相比，STB患者更有可能拥有私人保险，居住在收入较高且贫困程度较低的地区（通过与社会剥夺指数的关联）。存在年龄与性别的交互作用（z = 48.22；P <.001）；年龄较大的STB患者中女性的比例高于年龄较小的患者。自杀行为大多涉及摄入伤害（7121例[43%]）或锐器或钝器伤害（6518例[39%]）。此外，68897名患者有多次急诊科就诊（18%），6537名患者有多次STB就诊（10%）；187864次再次急诊科就诊中有117377次在3个月内（62%）。STB与因STB再次前往急诊科就诊密切相关（调整后比值比，9.71[99%置信区间：9.66 - 9.76]；z = 127.93）。1年内再次出现STB就诊在女性以及合并更多MH疾病、首次就诊时间更长且没有私人保险的患者中更为常见。
自杀风险在儿童中很常见，但仍未得到充分研究。早期自杀风险与复发性STB相关，尤其是在急诊科出院后的几个月内。了解儿童中的风险和保护因素可以加强急诊科筛查、干预和后续护理。
