Community Aftercare Linkage and Acute Clinical Outcomes Among Patients Presenting to the Emergency Department Following Suicide Attempts: A Retrospective Cohort Study

Background/Objectives: This study examined factors associated with successful community aftercare linkage after emergency department (ED) presentation following suicide attempts, with acute hospital outcomes evaluated separately. Methods: This single-center retrospective cohort included 1035 patients aged ≥ 15 years presenting during 2023–2025. Successful linkage was defined as confirmed initial registration at a community mental health center. Multivariable logistic regression assessed linkage among 975 discharge survivors; intensive care unit (ICU) admission and in-hospital mortality were secondary outcomes in the full cohort. Results: Among survivors, 530 (54.4%) accepted hospital-based case management and 213 (21.8%) achieved linkage, representing 40.2% of accepting survivors. College attendance (adjusted odds ratio [aOR], 1.69; 95% confidence interval [CI], 1.12–2.55), psychiatric history (aOR, 1.69; 95% CI, 1.13–2.55), and previous suicide attempts (aOR, 1.81; 95% CI, 1.27–2.56) were associated with linkage. The intubation estimate was uncertain (aOR, 0.52; 95% CI, 0.26–1.06). Model discrimination was modest (area under the receiver operating characteristic curve, 0.710), with evidence of lack of fit (Hosmer–Lemeshow p = 0.009). ICU admission occurred in 218 patients (21.1%) and in-hospital death in 60 (5.8%). Conclusions: Initial acceptance and completed linkage were distinct stages of this care pathway. The associated factors may inform further investigation of care transitions, but initial registration does not establish sustained treatment engagement.