Key Takeaways

From the Authors As published in the article
  1. Recurrent emergency department (ED) visits for self-injurious thoughts and behaviors (SITB) in adolescents remain poorly understood, despite their increasing prevalence. Understanding these patterns is essential to improve continuity of care and suicide prevention strategies.
  2. Previous SITB and nonheterosexual orientation were identified as key predictors of ED revisits, underscoring the need for individualized follow-up and early intervention in these high-risk groups.
  3. Systematic assessment and continuity of care following an initial ED visit are essential to reduce recurrence and improve suicide prevention efforts among adolescents presenting with SITB.
Extended Takeaways
  1. Revisit risk was front-loaded: 29 events had occurred by 15 days, 43 by 1 month, and 69 by 2 months, suggesting that follow-up intensity may need to be greatest in the first weeks after discharge.
  2. Within 6 months, 25.4% of patients returned for SITB, while the Kaplan–Meier estimate showed a survival rate of 74.6% at the end of follow-up, indicating that roughly 1 in 4 youths re-presented despite standard emergency care.
  3. Several markers of clinical complexity were associated with ED return in the Cox model, including previous mental health hospitalizations (HR = 1.363, 95% CI [1.107–1.679], P = .004), comorbidities (HR = 1.894, 95% CI [1.258–2.850], P = .002), and eating problems (HR = 1.560, 95% CI [1.070–2.272], P = .021).
  4. Contextual and psychosocial factors also mattered: family conflicts were associated with revisit risk (HR = 1.486, 95% CI [1.012–2.182], P = .043), reinforcing the value of assessing the home environment rather than focusing only on the index suicidal presentation.
  5. The type of initial presentation did not clearly separate low- and high-risk groups, as return rates were 21.7% for NSSI, 25.8% for suicidal ideation, and 25.3% for suicide attempts, and some youths returned with a different form of SITB than at index visit.
  6. Treatment changes at the prior emergency visit were associated with later return (HR = 2.212, 95% CI [1.177–4.159], P = .014), which may help clinicians identify a subgroup whose acute presentation required escalation and warrants closer post-ED monitoring.
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