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Pediatric Emergency Department Suicidal Patients: Two-Site Evaluation of Suicide Ideators, Single Attempters, and Repeat Attempters

NCJ Number
Journal of the American Academy of Child and Adolescent Psychiatry Volume: 47 Issue: 8 Dated: August 2008 Pages: 958-966
Joan Rosenbaum Asarnow Ph.D.; Larry J. Baraff M.D.; Michele Berk Ph.D.; Charles Grob M.D.; Mona Devich-Navarro Ph.D.; Robert Suddath M.D.; John Piacentini Ph.D.; Lingqi Tang Ph.D.
Date Published
August 2008
9 pages
In an attempt to clarify optimal strategies for pediatric emergency department (ED) management and risk assessment, this large clinical study of youth ED patients presenting with suicidality examined suicide ideators, single attempters, and repeat attempters.
The results support the hypothesis that suicidal youth emergency department (ED) patients fell along a continuum of increasing suicide attempt risk. As expected, given that depression is a strong predictor of suicide/suicide attempts, 79 percent of youths reported severe depression and depression levels increased as youth, particularly males, progressed along the risk continuum. The data also underscores the significance of other psychopathology: 58 percent of youth fell in the clinical range for externalizing problems, 53 percent screened positive for posttraumatic stress disorder (PTSD) symptoms, 30 percent fell in the clinical range for thought problems, and 17 percent reported probable substance use problems. These results are consistent with the view that higher levels of aggression and impulsive traits increase the likelihood that suicidal ideation will progress to suicide attempts and research indicating that behavioral/conduct problems, substance use, and thought disorder are associated with lethal suicide attempts. Suicidal youth ED patients represent a particularly high-risk group because most youths making medically dangerous attempts are treated in the ED and these youth are at risk for repeat and potentially fatal attempts. In an attempt to improve care for suicidal youth presenting to the ED, this study had three aims: (1) compare suicidal youth ED patients across two ED sites that differ in their sociodemographic and background characteristics; (2) conceptualize non-attempting suicidal youth, single attempters, and repeat attempters as falling along a continuum of increasing suicide attempt risk and hypothesize that increasing depression, substance use, and externalizing/conduct problems would be associated with higher attempt risk; and (3) conduct a sex-specific analyses exploring factors associated with suicide attempt risk in males. Tables and references