Demographic, Socioeconomic, and Clinical Determinants of Repeat Suicide Attempts: A Retrospective Study of Emergency Department Visits at a Community Hospital

Suicide is a critical public health issue in the United States, yet research is lacking on understanding the population that visits the Emergency Department (ED) for repeated suicide attempts (SA) and self-harm (SH).  Aims: Our aims are to identify and describe the population that revisits the ED for SA/SH, and to determine the factors that influence revisit rates.  Methods: This retrospective study was conducted from August 2022 to April 2024, reviewing ED visits from January 2019 to December 2021 at a single center. Data on demographics, diagnoses, family history, stressors, and outpatient care were analyzed. Statistical analyses, including Kruskal-Wallis, Mann-Whitney U, and correlation, were conducted.  Results: Among 138 participants (mean age 34.47 years), 83 (60.14%) were female, 86 (62.32%) were White, and 77 (55.80%) were on Medicaid. Psychiatric illness was present in 118 (85.51%), with depressive disorders most common, 76 (64.41%). Almost half of participants, 64 (46.38%), had a family psychiatric history, 28 (20.29%) participants had a diagnosis of hypertension and they had a significantly higher average revisit rate (p = 0.049), and 64 (46.38%) participants used a substance during SA/SH, with alcohol being the most frequently used. Oral medication was the most common method for SA, 145 (54.92% of SAs). Prior to the study period, 43 participants (31.16%) had seen a PCP, and only 70 ED visits (20.23%) resulted in scheduled outpatient follow-up. No significant differences were found between revisits and sex, age, payer status, or income (P > 0.05).  Conclusions: Our study demonstrated that psychiatric illness, substance use, and a family history of psychiatric disorders were highly prevalent among individuals with repeat ED visits for SA/SH. We propose that improving scheduled follow-up care after an event, encouraging PCP suicide-risk assessment, and medication management could serve as key intervention areas to reduce reattempts. Future research should focus on targeted interventions for high-risk populations, such as those with chronic diseases such as hypertension.