Associations Between the Child Opportunity Index and Suicide Risk Factors Among Pediatric Emergency Department Youth

We evaluated associations between Child Opportunity Index (COI) and risk factors for suicide attempt(s) and/or death among youth with increased suicide risk in the emergency department (ED). We hypothesized that lower COI was associated with increased odds of risk factors.

This single-center retrospective cohort study included youth of 10-18 years old who presented to the pediatric ED during July 2020-June 2024, screened positive during routine administration of the Ask Suicide-Screening Questions (ASQ) tool, and completed a psychosocial risk questionnaire. Individual data were linked to state-normed COI 3.0 data for 2021. We used age-adjusted multivariable logistic regression models to examine associations between COI and each risk factor.

Among 873 youth, most were female, White, Hispanic, and publicly insured, and the median age was 15 years. Most resided in the 'very low' (42%) or 'low' (23%) COI quintile. There was a statistically significant association between COI and access to firearms (p < .001). Youth from 'very high' compared to 'very low' COI quintiles had increased odds of access to household firearms (adjusted odds ratio (aOR): 5.76; 95% CI (confidence interval): 3.12, 10.6). There were no statistical associations between COI and other risk factors.

In this cohort of youth with elevated suicide risk in the ED, higher COI was associated with increased odds of access to household firearms. COI was not associated with other known risk factors for suicide attempt(s) and/or death. National studies examining the relationship between COI and firearm access among youth with suicidality may be needed to inform risk reduction interventions and guide suicide prevention strategies.