Frequently Asked Questions

Within 6 months, 25.4% of children and adolescents returned to the emergency department for self-injurious thoughts and behaviors (SITB). In this study of 429 patients younger than 18 years who presented with suicidal behavior, the Kaplan-Meier analysis showed a survival rate of 93.2% at 15 days, 90.0% at 1 month, 83.9% at 2 months, and 74.6% at the end of follow-up, indicating that revisit risk was concentrated early after the index visit.

The 2 variables independently associated with returning to the emergency department were nonheterosexual sexual orientation and prior suicidal behavior. In the adjusted model, nonheterosexual sexual orientation was associated with return with an odds ratio of 2.10 (95% CI, 1.14-3.87), and prior suicidal behavior was associated with return with an odds ratio of 2.14 (95% CI, 1.27-3.60).

In the Cox regression analysis, several psychosocial and clinical factors were associated with returning to the emergency department for SITB. These included family conflicts (HR = 1.486, 95% CI, 1.012-2.182; P = .043), LGBTIQ+ status (HR = 1.447, 95% CI, 1.035-2.022; P = .031), sexual orientation (HR = 2.099, 95% CI, 1.137-3.875; P = .018), previous mental health follow-up (reported as HR = 1.355; P < .001), previous mental health hospitalizations (HR = 1.363, 95% CI, 1.107-1.679; P = .004), prior suicidal behavior (HR = 2.019, 95% CI, 1.218-3.348; P = .006), presence of comorbidities (HR = 1.894, 95% CI, 1.258-2.850; P = .002), 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).

The return rates were similar across the 3 main types of initial presentation. Within 6 months, 21.7% of patients who first presented with nonsuicidal self-injury returned, compared with 25.8% of those who presented with suicidal ideation and 25.3% of those who presented with a suicide attempt.

Patients did not always return with the same type of self-injurious thought or behavior. The authors noted switching between presentation types, particularly from suicidal ideation to suicide attempt.

This was a prospective observational study of all patients younger than 18 years who attended the psychiatric emergency department of a large tertiary hospital in Madrid, Spain, between January 2, 2022, and November 30, 2023. The primary outcome was return to the emergency department for suicidal behavior within 6 months.

SITB was defined to include suicide attempts, suicidal ideation, and nonsuicidal self-injury. The authors used baseline semistructured clinical interviews, electronic health records, Kaplan-Meier survival curves, and Cox proportional hazards regression to examine time to first return visit and factors associated with revisiting.

Among 713 patients treated in the emergency department during the study period, 429 patients (60.16%) presented with suicidal behavior and were analyzed for this question. Of these, 38.7% had attempted suicide, 26.8% had nonsuicidal self-injury, and 33.6% had suicidal thoughts only.

The sample was 83.2% female, with ages ranging from 7 to 17 years and a mean age of 14.6 years. A prior history of suicidal behavior was present in 73.2% of patients, 52.4% had a family history of mental illness, and 49.0% were already receiving follow-up care in mental health services.

No. The authors reported that gender identity did not suggest being a factor associated with emergency department revisits for suicidal behavior in this sample.

They also noted that this finding differs from some prior studies and suggested that the small number of transgender participants in their sample could be one possible explanation.

The main limitations were that some data were collected through medical record review, suicidal intent was not always fully clear from case records, and only clinical diagnoses were collected without standardized rating scales. The authors also noted that some patients may have presented to other facilities during follow-up, which could have led to underestimation of repeat emergency department visits.

In addition, there were no deaths by suicide or other unnatural causes during the 6-month follow-up, so the study could not evaluate mortality outcomes.