Association of Suicide Risk Factors and Subsequent Pediatric Emergency Department Mental Health Visits

Objectives: Pediatric emergency department (ED) visits for mental and behavioral health concerns are rising. Understanding psychosocial predictors of ED mental health visits among youth with elevated suicide risk may inform tailored interventions and/or targeted resource allocation, decreasing ED utilization. We examined the association between self-reported psychosocial risk factors among youth screened “at-risk” for suicide during a nonmental health index ED visit and subsequent ED mental health visits. Methods: This single-center retrospective cohort study had an exploratory, hypothesis-generating design. We included youth aged 10 to 18 years who presented to the ED between July 2020 and June 2023 for a nonmental health concern, were identified as “at-risk” for suicide during universal screening, and completed a psychosocial risk questionnaire. Subsequent ED mental health visits were tracked for 6 months after the index encounter, through December 2023. Psychosocial factors were compared between youth with and without a subsequent mental health visit using χ 2 and Fisher exact tests. Multivariable logistic regression models assessed associations between risk factors and subsequent ED mental health visits. Results: Of 740 youth, 88 (11.9%) had a subsequent ED mental health visit, most (69.3%) for suicidal ideation. Youth were female (70.9%), non-White (63.6%), Hispanic (50.7%), publicly insured (71.8%), and the median age was 15.2 years; many (48.9%) had no known mental health conditions. For the subgroup with prior ED mental health visit(s), the odds of a subsequent ED mental health visit were higher in youth who identified as sexual and gender minority (aOR: 3.05; 95% CI: 1.15, 8.09) and individuals who reported prior nonsuicidal self-injury (aOR 3.01; 95% CI: 1.05, 8.66). Conclusions: Our results suggest a potential subpopulation, youth screened at-risk for suicide who identify as sexual and gender minority or report prior nonsuicidal self-injury, who may benefit from tailored interventions and/or resources to decrease subsequent ED utilization.