6119 Retrospective review of adolescent suicide and self-harm attempts presenting to a paediatric emergency department in Singapore

Objectives This study aims to describe the risk profiles of adolescents who present to an emergency department (ED) for suicide and self-harm attempts. Identification of risk factors in terms of demographics, psychosocial stressors, psychiatric morbidities, and prior healthcare seeking behaviour will help with early recognition of at-risk adolescents. Methods The electronic health records of adolescents aged 10 to 19, who presented to the ED of KK Women's and Children's Hospital, the largest paediatric hospital in Singapore, for suicide or self-harm attempt, from January to December 2021, were retrospectively reviewed. Data collected included patient demographics, clinical presentations, psychosocial and psychiatric evaluations, past medical history, and healthcare utilisation in the past year. Results From January to December 2021, 260 ED attendances met the inclusion criteria, with 221 unique patients. Patient demographics revealed a disproportionately larger number of female (85.5%) to male (14.5%) patients. Majority were 13-to-16 (85.1%). There was an over-representation of Malays and minority ethnic groups compared to the national adolescent statistics. July had the highest attendance (13.8%), after the lowest trough in June (4.2%). Majority of attendances were for intentional drug overdose (74.2%), with paracetamol being the commonest drug used (55.9%). Other methods included cutting (16.9%) and jumping from height (6.5%). 35.8% of attempts had suicidal intent, whilst 51.5% were ambivalent. More than three quarters of patients had a history of non-suicidal self-injury (76.5%) and almost half had prior suicidal attempts (48.8%). Other prominent psychosocial factors identified were sleep problems (42.3%), parent-child problems (35.0%), academic stress (35.0%), parental-marital issues (34.2%), and peer conflict (28.9%). Individual psychiatric evaluations revealed stress-related and emotional coping difficulties (52.9%), and mood and anxiety difficulties (53.8%), as the top two mental health issues. Within the past year of attendance, 16.7% had attended a healthcare institution for suicidal-related or self-harm behaviour, 19.5% for medically unexplained symptoms, possibly psychosomatic, and 15.4% for common mild ailments. Conclusion The risk factors and associations identified in this study inform strategic opportunities for early recognition and intervention. Presentations to healthcare institutions for possible psychosomatisation or common mild ailments represent 'safety-net' opportunities which should be seized for screening. Most do not have mental health disorders and hence may not require tertiary mental health services early on. Efforts to build psychological resilience through transdiagnostic psychological interventions, to complement social and pastoral care support, hold much promise. Future studies should investigate the identified risk factors in greater detail to develop targeted solutions to prevent future suicide and self-harm attempts.