Recency of Suicide Attempt, Ideation, and Reattempt in the Emergency Department: Managing Youth With a Past Attempt

Abstract

Objective: This study describes recency of suicide attempt (SA) and suicidal ideation (SI) at index emergency department (ED) visit and post-ED-discharge reattempt among pediatric patients. Methods: Secondary analysis from the ED Screen for Teens at Risk for Suicide study included patients ages 12–17 who reported a past SA during screening and received a phone call 3-month post-ED-discharge assessing reattempt. Logistic regressions tested past SA/SI recency as predictors of reattempt. Descriptive statistics on SA/SI recency and reattempt are provided. Results: Sample included 351 patients reporting a past SA during screening (70% cisgender female, 59% White, 53% psychiatric chief complaint, mean [SD] age = 15.3 [1.5]). 17% (60/351) reattempted suicide post-ED-discharge. Compared to patients who attempted over a year ago, patients with recent SA within 3 months, especially 1 week before screening, had greater odds of reattempting (3 months: p < 0.05, adjusted odds ratio [adjOR] = 3.1 [1.1–10.4]; 1 week: p < 0.01, adjOR = 4.8 [1.7–16.2]). Patients with recent SI within 24 h before screening had greater odds of reattempting than those with no recent SI (adjOR = 2.8 [1.1–7.6]; p < 0.05). 94% (64/68) of patients with a SA from over a year ago and no recent SI did not reattempt at follow-up. Conclusions: Pediatric ED patients have greater risk of reattempting suicide post-discharge if their last SA was within the past 3 months−especially 1 week−and when most recent SI occurred within 24 h. Conversely, patients reporting SA over a year ago with no recent SI may require less immediate intervention. Findings support universal suicide risk screening and clinical pathways that use recency of SA to inform disposition.