The emergency department in surveillance of attempted suicide: findings and methodologic considerations

The authors conducted one of the first active, population-based public health surveillance systems for detecting suicide attempts in the United States. Surveillance was conducted in all four hospital emergency departments serving a county suburban to Atlanta, GA, with a population of 426,000. Emergency department staff gathered information from all patients who presented with an intentionally self-inflicted injury (suicide attempt) or with thoughts about self-injury (suicidal ideation). During an 18-month period in 1988 and 1989, 798 suicide attempt-related patients were reported, for a rate of 124.7 per 100,000 county residents per year. Females had a higher attempted suicide rate than males, but males had a higher completed suicide rate. Ingestion of drugs or poison was the most common method of attempted suicide (71.1 percent), and use of firearms was the most common method of completed suicide (69.8 percent). In comparing reported cases with those found by reviewing emergency department log books, the authors found that the case reports were 58 percent complete and that surveillance reporting was highly representative of all cases requiring emergency transport. The authors conclude that emergency department-based surveillance for attempted suicide is feasible. It can provide representative data that may be used to monitor trends in attempted suicide and to define high-risk groups. Such surveillance may also allow timely detection of suicide attempt clusters, facilitating prompt intervention.