Lifetime Emergency Department Utilization Among American Indian Adolescents Who Made a Suicide Attempt

Introduction: Reservation-based American Indian (AI) adolescents have suicide rates 4-15 times that of national samples and experience significant health care disparities.  Medical service provision on reservations is typically limited to a local emergency department (ED), which treat these at-risk adolescents across the lifespan.  ED utilization in the years before suicide attempt in a sample of AI adolescents was evaluated to illuminate specific opportunities for screening and early identification in this population.

Methods: Cross-sectional study of Apache adolescents (aged 13-19) who attempted suicide and consented to medical chart review.  Lifetime presenting complaints for Indian Health Service ED visits were extracted and coded prior to the index attempt.

Results: 1424 ED visits from 72 Apache adolescents were extracted (Median lifetime visits: 18, Range: 2 to 52). 60% were female with a mean age of 16.7 years (SD: 0.9).  In the year before attempt, 82% of participants had an ED visit for any reason, 41% for a trauma or injury related reason and 26% for a psychiatric reason.  Suicidal thoughts or behavior were coded in the first three presenting concerns on ED visit for five participants (7%) in the year before attempt.

Conclusion: Service utilization data suggest that EDs are critical locations for reservation-based suicide prevention. The majority of AI adolescents had an ED visit in the year before their suicide attempt; however relatively few were seen for psychiatric reasons. Screening in ED settings, including patients with medical or injury-related presenting complaints, may be a critical strategy to increase identification of individuals at risk for suicide and prevent suicide attempts and deaths.