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.