Comparing patterns of recent mental health service use for predicting suicidal events following emergency department mental health visits in the United States: A national cohort study

Objective To examine patterns of recent service use to predict non-fatal suicidal events shortly following emergency department (ED) visits for mental health. Methods For this retrospective cohort study, we used Optum electronic health record data from 2,445,597 ED mental health episodes (2015–2022) for persons aged ≥ 10 years. We then constructed a series of logistic regression models to evaluate how six permutations of characterizing prior 180-day mental health service use predicted acute non-fatal suicidal events within 180 days of ED discharge beyond demographic characteristics and ED mental health diagnoses. Model performance was assessed by area under the receiver operating curve (AUC). Results Overall, 7.2% ( n = 176,000) of episodes resulted in an acute suicidal event within 180 days. Model performance improved from demographic characteristics and ED mental health diagnoses (AUC = 0.76) when past 180-day service use variables were added, but with minimal differences between a binary variable of any mental health service use compared to monthly counts, weighted slopes, or interactions (AUC’s 0.78–0.82). The final model containing demographics, ED mental diagnosis, and past 180-day service use yielded an AUC of 0.83. The most predictive past service use variables were any inpatient or ED event for self-harm or suicide ideation (OR = 5.45, 95% CI = 5.37, 5.54) and any ED mental health visit (OR = 1.87, 95% CI = 1.84, 1.90). Conclusions As part of evaluating suicide risk in ED settings, information about recent acute care for mental health, suicidal ideation, or self-harm use significantly contributes to the short-term prediction of non-fatal suicidal events.