Number of visits to the emergency department and risk of suicide: a population- based case–control study

Abstract

BackgroundThe aim was to study whether number of visits to emergency department (ED) is associated with suicide, taking into consideration known risk factors.MethodsThis is a population-based case–control study nested in a cohort. Computerized database on attendees to ED (during 2002–2008) was record linked to nation-wide death registry to identify 152 cases, and randomly selected 1520 controls. The study was confined to patients attending the ED, who were subsequently discharged, and not admitted to hospital ward. Odds ratio (OR) and 95% confidence intervals (CI) of suicide risk according to number of visits (logistic regression) adjusted for age, gender, mental and behavioral disorders, non-causative diagnosis, and drug poisonings.ResultsSuicide cases had on average attended the ED four times, while controls attended twice. The OR for attendance due to mental and behavioral disorders was 3.08 (95% CI 1.61-5.88), 1.60 (95% CI 1.06-2.43) for non-causative diagnosis, and 5.08 (95% CI 1.69-15.25) for poisoning. The ORs increased gradually with increasing number of visits. Adjusted for age, gender, and the above mentioned diagnoses, the OR for three attendances was 2.17, for five attendances 2.60, for seven attendances 5.97, and for nine attendances 12.18 compared with those who had one visit.ConclusionsNumber of visits to the ED is an independent risk factor for suicide adjusted for other known and important risk factors. The prevalence of four or more visits was 40% among cases compared with 10% among controls. This new risk factor may open new venues for suicide prevention.

Patterns of Health Care Usage in the Year Before Suicide: A Population-Based Case-Control Study

“…One interpretation of this finding is that mental health diagnosis is associated with a higher number of emergency department visits, which others have similarly described. 6,10,21 A recent case-control study nested in the cohort of patients presenting to the emergency department in Reykjavik, Iceland found that suicide risk increased with the number of ED visits in a dose-response matter even after controlling for age, gender and psychiatric diagnoses. 10 …”

“…A handful of case-control studies comparing patterns of healthcare utilization between suicide cases and members of the general population have been conducted in Canada, 6,7 Taiwan, 8 the United Kingdom, 9 Iceland 10 and Denmark 11 as well as among U.S. military service members 12 and on an Indian reservation in the upper Midwest. 13 These studies largely focus on specific types of visits rather than overall patterns of healthcare use; for example, outpatient visits to general practitioners and/or mental health providers, 7–9,12 emergency department visits 10 or inpatient hospitalizations. 11 Only one compares patterns of healthcare utilization in outpatient, inpatient, emergency and community mental health settings among adults in Alberta, Canada.…”

“…6,10–12 One study found no difference in the month before death but increased utilization by cases in the 10 years prior, 9 and a single study found a decreased likelihood of accessing health care in the six months prior to suicide. 13 In addition to non-uniform assessments of healthcare utilization, the generalizability of these studies is limited due to differences between these healthcare systems and populations and that of the United States.…”

Lethal Means Access and Assessment Among Suicidal Emergency Department Patients

“…Emergency departments (EDs) are a key setting for suicide prevention, as up to 8% of all ED patients have active or recent suicidal ideation (SI), [4-6] multiple ED visits appear to be a risk factor for suicide, [7] and many suicide victims are seen in an ED shortly before death. [8] Based on models using national suicide statistics, ED-based interventions might help decrease suicide deaths by 20% annually.…”

“…[2] Reducing access to firearms (e.g., through locked storage at home or through storage out of the home) is particularly important, since firearm suicide attempts (SAs) have a high case-fatality rate and firearms account for 51% of all suicide deaths in the United States. [3] Emergency departments (EDs) are a key setting for suicide prevention, as up to 8% of all ED patients have active or recent suicidal ideation (SI), [4][5][6] multiple ED visits appear to be a risk factor for suicide, [7] and many suicide victims are seen in an ED shortly before death. [8] Based on models using national suicide statistics, EDbased interventions might help decrease suicide deaths by 20% annually.…”