PURPOSE: Reservation-based American Indian adolescents are at significant risk for suicide. Preventive approaches have not focused on medical service utilization patterns on reservations, which are typically limited to one local emergency department (ED). Patterns of ED utilization before suicide attempts were evaluated to identify opportunities for screening and intervention. METHODS: Cross-sectional study of Apache adolescents (aged 13-19 years) who attempted suicide and consented to medical chart review. Lifetime presenting problems for Indian Health Service ED visits before the index suicide attempt were extracted and coded. RESULTS: A total of 1,424 ED visits from 72 Apache adolescents were extracted (median lifetime visits, n = 18). In the year before the attempt, 82% (n = 59) of participants had had an ED visit for any reason and 26% (n = 19) for a psychiatric reason, including suicidal thoughts or self-harm. CONCLUSIONS: Service utilization data suggest that EDs are critical locations for reservation-based suicide prevention. Suicide screening for all ED patients could increase early identification and treatment of this at-risk group.
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