Past-Year Emergency Department Utilization Patterns Among Suicide Decedents: Characterizing At-Risk Patient...

Frequent past-year emergency department (ED) use is a risk factor for suicide but also presents an intervention opportunity. This study aimed to quantify ED visit timing among suicide decedents by past-year ED use and characterize differences between suicide decedents and other ED patient populations.

ED records were obtained from the North Carolina Disease Event Tracking and Epidemiological Collection Tool (NC DETECT), and death records were obtained from the NC Violent Death Reporting System (NC-VDRS). ED visits corresponding to the decedent's suicide were probabilistically linked to their corresponding death record. Decedents were classified as frequent (≥4) and infrequent (<4) users based on nonfatal ED visits occurring within one year of their death. Timing from decedents' final nonfatal visit to death was assessed. Decedents' demographics and visit characteristics were compared with all ED patients and mental health patients, stratified by past-year use.

From 2019 to 2020, 670 of 2,883 NC-VDRS suicide decedents linked to an ED visit associated with their suicide. One third (n=213) of linked decedents had past-year ED use. Among these individuals, 21.6% (n=46) were frequent users. Within 30 days of their final nonfatal visit, only 28% of frequent users survived, compared with 65% of infrequent users (difference: -36.4% [-51.3% to -21.5%]). Suicide decedents with frequent use were distinct from infrequent users and from both reference groups regarding demographic and visit-level characteristics.

Suicide decedents who visited the ED once or who were frequent users were demographically distinct from the overall population of ED patients. Timing from final nonfatal ED visit to death by suicide varied with past-year use.