Clinical Summary
Clinical Summary: Factors Associated With Revisiting the Emergency Department due to Suicidal Behavior in Children and Adolescents
A substantial share of youths who present to the emergency department for suicidal ideation, suicide attempt, or nonsuicidal self-injury return within months, often while risk remains high in the early postdischarge period. Identifying which children and adolescents are most likely to come back can help clinicians target follow-up, safety planning, and family-based intervention after the index visit.
Design
This prospective observational study
N
429
Population
All patients under the age of 18 years who attended the psychiatric ED of the University Hospital 12 de Octubre (Madrid, Spain) between January 2, 2022, and November 30, 2023, were included.
Duration
within the following 6 months
Key Findings
- Within 6 months of the initial ED visit, 25.4% of patients returned for SITB; return rates were 21.7% after an index visit for NSSI, 25.8% after suicidal ideation, and 25.3% after suicide attempts.
- In the adjusted model, the variables independently associated with returning to the ED for suicidal behavior were nonheterosexual sexual orientation (odds ratio [OR] = 2.10, 95% CI [1.14–3.87]) and prior suicidal behavior (OR = 2.14, 95% CI [1.27–3.60]).
- Risk concentrated early: the survival analysis showed 29 events with a 93.2% survival rate at 15 days, 43 events with a 90% survival rate at 1 month, and 69 events with an overall rate of 83.9% by 2 months.
- Several psychosocial and clinical complexity markers were associated with revisit risk in the Cox model, including family conflicts (hazard ratio [HR] = 1.486, 95% CI [1.012–2.182], P = .043), previous mental health hospitalizations (HR = 1.363, 95% CI [1.107–1.679], P = .004), and comorbidities (HR = 1.894, 95% CI [1.258–2.850], P = .002).
- Additional Cox-model correlates of return included sexual orientation (HR = 2.099, 95% CI [1.137–3.875], P = .018), LGBTIQ+ status (HR = 1.447, 95% CI [1.035–2.022], P = .031), eating problems (HR = 1.560, 95% CI [1.070–2.272], P = .021), and treatment adjustments during the previous emergency visit (HR = 2.212, 95% CI [1.177–4.159], P = .014).
Clinical Bottom Line
About 1 in 4 youths returned to the ED for self-injurious thoughts and behaviors within 6 months, with risk especially concentrated in the first 2 months. Prior suicidal behavior and nonheterosexual sexual orientation stood out as the clearest independent markers for intensified post-ED follow-up.
Practice Implications
- Plan the most intensive follow-up early after discharge, because 29 return events occurred by 15 days and 69 by 2 months.
- Treat prior suicidal behavior as a high-priority triage signal for recurrence risk, given its independent association with return (OR = 2.14, 95% CI [1.27–3.60]).
- Include affirming assessment of sexual orientation in the ED evaluation and follow-up plan, since nonheterosexual sexual orientation was independently associated with return (OR = 2.10, 95% CI [1.14–3.87]).
- Broaden the risk assessment beyond the index suicidal presentation to include family conflicts, comorbidities, eating problems, and prior mental health hospitalization, all of which were associated with revisits in the Cox model.
