Suicide Risk is High Among Patients Admitted for Self-Harm Following Hospital Discharge

The findings of a new study suggest that patients admitted to the emergency department (ED) for nonfatal deliberate harm or suicidal ideation have a high risk of suicide in the year following ED discharge. The study appeared in JAMA Network Open.

In this retrospective cohort study, researchers evaluated 648,646 individuals who presented to a California-licensed ED at least 1 time from January 1, 2009, to December 31, 2011, with deliberate self-harm, suicidal ideation but not self-harm, or neither. The researchers utilized statewide mortality data to discern Age-, sex-, and race/ethnicity-adjusted standardized mortality ratios (SMRs) for suicide and other manners or causes.

The main endpoint was specified as suicide and other manners or causes of death were ascertained using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Suicide rate and all mortality rates were measured per 100 000 person-years. The researchers analyzed the study data from January 10 to July 18, 2019.

Subsequent to analysis, the results showed that the rates of suicides per 100,000 person-years in the year following ED presentation were 693.4 deaths among 83,507 individuals presenting with deliberate self-harm (SMR=56.8; 95% CI, 52.1 to 61.4), 384.5 deaths among 67,379 individuals presenting with suicidal ideation but not self-harm (SMR=1.4; 95% CI, 27.5 to 35.2), and 23.4 deaths among 497,760 reference patients (SMR, 1.9; 95% CI, 1.6 to 2.3). Compared with the demographically matched general population, the rates of nonsuicide external-cause mortality were also increased among patients with self-harm (SMR, 14.2; 95% CI, 12.9-15.5), patients with suicidal ideation (SMR, 11.8; 95% CI, 10.6-13.0), and reference patients (SMR, 2.2; 95% CI, 2.0-2.3).

Moreover, the researchers observed that among all three groups, the rates of suicide mortality per 100,000 person-years were higher among men, the elderly (65 years or older), and non-Hispanic white were higher juxtaposed to their referenced groups.

“These findings suggest that ED patients with deliberate self-harm or suicidal ideation are associated with substantially increased risk of suicide and other mortality during the year after ED presentation,” the research authors wrote in concluding their findings.

“The process of planning for ED discharge may present opportunities to help ensure safe transitions to continuing outpatient mental health care and to consider broader risk for unintentional injury and other causes of premature mortality.”