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

• Published in: Journal of child psychology and psychiatry Vol. 60; no. 10; pp. 1055 - 1064
• Main Authors: King, Cheryl A., Grupp‐Phelan, Jacqueline, Brent, David, Dean, J. Michael, Webb, Michael, Bridge, Jeffrey A., Spirito, Anthony, Chernick, Lauren S., Mahabee‐Gittens, E. Melinda, Mistry, Rakesh D., Rea, Margaret, Keller, Allison, Rogers, Alexander, Shenoi, Rohit, Cwik, Mary, Busby, Danielle R., Casper, T. Charles
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-10-2019
• Subjects: adolescence; Adolescents; Applied research; Child & adolescent psychiatry; Connectedness; emergency department; Emergency medical care; Emergency services; Health services; Help seeking behavior; Injuries; Males; Men; Pediatrics; Protective factors; Risk factors; Self destructive behavior; Severity; social connectedness; Suicidal ideation; Suicide; suicide attempt; Suicide risk; Suicides & suicide attempts; Teenagers; United States > US; Suicide risk; adolescence; social connectedness; suicide attempt; emergency department
• ISSN: 0021-9630; 1469-7610
• DOI: 10.1111/jcpp.13087

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.