Pediatric emergency department suicidal patients: two-site evaluation of suicide ideators, single attempters, and repeat attempters
Abstract
Objective Reducing youth suicide and suicide attempts are national priorities. Suicidal youth emergency department (ED) patients are at high risk for repeat and fatal attempts, yet information is lacking to guide service delivery. In one of the largest clinical studies of youth ED patients presenting with suicidality, we examine ideators, single attempters, and repeat attempters with the aim of clarifying optimal strategies for ED management and risk assessment.Method Consecutively admitted suicidal youths (10-18 years) from two EDs (N = 210) completed a questionnaire assessing sociodemographic, clinical, service use, and environmental stress variables.Results Despite differences in background characteristics, high levels of depression, externalizing behavior, posttraumatic stress symptoms, substance use, and thought problems were observed across sites. Suicide attempt risk, defined along a continuum ranging from ideation to single attempts to repeat attempts, was predicted by higher levels of clinical symptoms, service use, and environmental stress. Specific stresses associated with increased suicide attempt risk were romantic breakups, exposure to suicide/suicide attempts, and pregnancy in self or partner. Significant predictors of attempt risk in the male-only subgroup were depression, thought problems, previous ED visits, and romantic breakups.Conclusions Pediatric ED patients presenting with suicidal ideation, single attempts, and repeat attempts fall along a continuum of increasing risk. Suicide attempt risk in males is associated with high levels of depression, but not with increased treatment rates, suggesting undertreatment in males, a group with particularly high risk for death by suicide. Treatment barriers must be addressed to achieve our national goal of reducing suicide/suicide attempts in youths.
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“8% of patients reporting an annual income of $30,000 or more and 80% of patients with health insurance.(14) The study population may not reflect the general U.”
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BackgroundResultCharacteristics and disposition of youth referred from schools for emergency psychiatric evaluation
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“outcomes of suicidal youth [7, 35], and there are at least two possible interpretations of our results.”
ResultAcute Poisoning among Children Admitted to a Regional University Hospital in Northern Greece
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“For this reason, the attention to poisoning prevention in this age group, and in particular those who are socially deprived should be increased (23, 24).”
BackgroundAssessment of Suicidal Youth in the Emergency Department
Berk, M. S., & Asarnow, J. R. (2014) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12133 · Cited by 21 · see citing works
Hughes, J. L., Anderson, N. L., Wiblin, J. L., & Asarnow, J. R. (2016) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12271 · Cited by 21 · see citing works
Berny, L. M., & Tanner‐Smith, E. E. (2022) · Journal of Dual Diagnosis · doi:10.1080/15504263.2021.2016343 · Cited by 19 · see citing works
“Studies conducted with adolescent clinical samples have reported that depression severity is associated with an elevated risk of suicide (Asarnow et al., 2008; Vitiello et al., 2009).”
BackgroundAsarnow, J. R., McArthur, D. L., Hughes, J. L., Barbery, V., & Berk, M. S. (2012) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.2012.00122.x · Cited by 18 · see citing works
“Readers interested in learning more about the randomized controlled trial are referred to our other manuscripts (Asarnow et al., 2008, 2011; Asarnow, Berk, & Baraff, 2009).”
May, A. M., Czyz, E. K., & West, B. T. (2020) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2020.04.018 · Cited by 18 · see citing works
“This pattern of findings is consistent with previous studies showing that some of the more consistent predictors differentiating suicidal ideators from attempters included substance misuse as well as externalizing or behavioral problems [3,15,16,18,19].”
BackgroundResultInfluentialPediatric Emergency Consultations: Prior Mental Health Service Use in Suicide Attempters
Frosch, E. J., McCulloch, J. R., Yoon, Y., & dosReis, S. (2009) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-009-9192-0 · Cited by 17 · see citing works
Danielsen, S., Strandberg‐Larsen, K., Hawton, K. E., Nordentoft, M., Erlangsen, A., & Madsen, T. (2024) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-024-02503-w · Cited by 14 · see citing works
“Since many adolescents, especially boys, do not present to hospital following a suicide attempt or receive psychiatric treatment afterwards [27–29 ], offer - ing help to individuals in the community is crucial for preventing repetition and addressing underlying mental health issues.”
Problem gambling during Covid-19
Frisone, F., Alibrandi, A., & Settineri, S. (2020) · Mediterranean Journal of Clinical Psychology · doi:10.6092/2282-1619/mjcp-2457 · Cited by 15 · see citing works
Emergency Department-Based Care Transitions for Pediatric Patients: A Systematic Review
Abraham, J., Kannampallil, T., Caskey, R. N., & Kitsiou, S. (2016) · PEDIATRICS · doi:10.1542/peds.2016-0969 · Cited by 14 · see citing works
Tillman, J. G., Clemence, A. J., Cree, R. A., Lewis, K. C., Stevens, J. L., & Reiss, D. (2017) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2017.05.005 · Cited by 13 · see citing works
Boege, I., Corpus, N., Schepker, R., & Fegert, J. M. (2014) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/1753-2000-8-28 · Cited by 13 · see citing works
“Many risk factors have been identified in the past: Personal factors [9], family factors [9,10], presence of mental illness [11].”
BackgroundJaycox, L. H., Morral, A. R., Street, A. E., Schell, T. L., Kilpatrick, D. G., & Cottrell, L. (2022) · Rand health quarterly · doi:10.7249/rhq-10-02-08 · Cited by 10 · see citing works
Using Behavioral Measures to Assess Suicide Risk in the Psychiatric Emergency Department for Youth
Shin, K. E., Baroni, A., Gerson, R. S., Bell, K., Pollak, O. H., Tezanos, K. M., Spirito, A., & Cha, C. B. (2023) · Child Psychiatry & Human Development · doi:10.1007/s10578-023-01507-y · Cited by 10 · see citing works
“Suicidal youth evaluated in the ED present different level of acuity, with some having attempted suicide and others experiencing intermittent or fleeting suicidal ideation; some youth from both groups will engage in suicide attempts after their ED visit [13].”
Luo, J., Liu, M., Feng, L., Li, Z., Wu, Y., Lu, J., & He, F. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1105534 · Cited by 10 · see citing works
La Conducta Suicida en la Adolescencia y sus Condiciones de Riesgo
Pacheco, B. E. P., & López, P. (2016) · ARS MEDICA Revista de Ciencias Médicas · doi:10.11565/arsmed.v40i1.38 · Cited by 9 · see citing works
Recognition of Suicide Risk, Crisis Helplines, and Psychosocial Interventions: A Selective Review
O’Connor, R. C., Rasmussen, S. A., & Beautrais, A. L. (2011) · doi:10.1002/9781119998556.ch25 · Cited by 9 · see citing works
Clinical Interviewing with Children
Young, J., Davidson, J. A., & Gross, A. M. (2009) · Springer eBooks · doi:10.1007/978-0-387-09757-2_8 · Cited by 8 · see citing works
Tabares, Á. S. G. (2023) · psicología desde el caribe · doi:10.14482/psdc.38.3.362.28 · Cited by 7 · see citing works
Lachal, J., Grandclerc, S., Spodenkiewicz, M., & Moro, M. R. (2018) · L Encéphale · doi:10.1016/j.encep.2018.01.004 · Cited by 8 · see citing works
Rodríguez-Quiroga, A., Flamarique, I., Castro‐Fornieles, J., Lievesley, K., Buitelaar, J. K., Coghill, D., Díaz‐Caneja, C. M., Dittmann, R., Gupta, A. K., Hoekstra, P. J., et al. (2019) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-019-01328-2 · Cited by 7 · see citing works
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Outcome of pediatric emergency mental health visits: incidence and timing of suicide
Lee, J., Black, T. R., Meckler, G. D., & Doan, Q. H. (2020) · Canadian Journal of Emergency Medicine · doi:10.1017/cem.2019.470 · Cited by 6 · see citing works
Berk, M. S., Starace, N., & Glasser, C. (2021) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2021.1941429 · Cited by 5 · see citing works
“As in the FISP/SAFETY-A intervention (Asarnow et al., 2008, 2009, 2011; Asarnow, Goldston et al., 2020), in the Crisis Clinic, we use a feelings thermometer to help the teen identify early warning signs that they may be escalating to the point of crisis, so they can use coping skills or ask for…”
BackgroundMethodPuzio, D., Bobeff, E. J., Bliźniewska-Kowalska, K. M., Lewandowska, A., & Gałecki, P. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06505-z · Cited by 4 · see citing works
“Youth who have experienced any kind of trauma – emotional, physical or sexual abuse was over 3 times more likely to report SA according to a recent study which analyzed chart reviews of over 850 pediatric patients in psychiatric emergency unit [15].”
Ezquerra, B., Peñuelas‐Calvo, I., Marti-Estevez, I., Taracena-Cuerda, M., Baca‐García, E., & Porras‐Segovia, A. (2024) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-024-02594-5 · Cited by 4 · see citing works
Managing suicidal behaviour in adolescents
Kerfoot, M. (2009) · Psychiatry · doi:10.1016/j.mppsy.2009.04.010 · Cited by 4 · see citing works
Association between suicide attempt and previous healthcare utilization among homeless youth
Bizmark, R. S., Kumamaru, H., Estevez, D., Bedel, L. E. M., Marr, E. H., Mena, L. A., & Kaplan, M. S. (2022) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12897 · Cited by 4 · see citing works
Lam, C., Han, L., McIntyre, R. S., Teopiz, K. M., & Cao, B. (2024) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2024.0017 · Cited by 4 · see citing works
“The prevalence of recurrent episodes, lack of recovery, impairment, comorbidity, and suicidality is signi fi cantly elevated among young individuals experiencing depressive episodes (Asarnow et al., 2008; Davey et al., 2019; Lopresti, 2015).”
Can glutathione be a biomarker for suicide risk in women 18 months postpartum?
Schmidt, P. M. D. S., Trettim, J. P., Longoni, A., Grings, M., de Matos, M. B., Quevedo, L. D. Á., Ardais, A. P., Nedel, F., Ghisleni, G., Leipnitz, G., et al. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1142608 · Cited by 4 · see citing works
“Glutathione is the brain’s main antioxidant, and recent post-mortem and genetic data support its involvement in the pathophysiology of bipolar disorder (20, 32, 33).”
BackgroundSánchez‐Teruel, D., León, A. G., & Muela-Martínez, J. A. (2014) · Anales de Psicología · doi:10.6018/analesps.30.3.148691 · Cited by 3 · see citing works
Suicide and Substance Abuse in Adolescents
Shlosberg, D., & Shoval, G. (2020) · Springer eBooks · doi:10.1007/978-3-030-36391-8_107 · Cited by 3 · see citing works
Impassioned Communication and Virtual Support Roles of Online Postings: The Case of Self-Harmers
Davis, S. M., & Lewis, C. A. (2018) · Illness Crisis & Loss · doi:10.1177/1054137318780585 · Cited by 2 · see citing works
Mutlu, C., Özdemir, M., Yorbık, Ö., & Kılıçoğlu, A. G. (2015) · Dusunen Adam The Journal of Psychiatry and Neurological Sciences · doi:10.5350/dajpn2015280401 · Cited by 2 · see citing works
“Düşünen Adam The Journal of Psychiatry and Neurological Sciences, Volume 28, Number 4, December 2015 Suicidality, from suicidal ideation to a single attempt and to multiple attempts, is thought to be a severity marker of psychopathology (17,18).”
BackgroundÁlvarez, M., Atienza, G., Ávila, M. J., Canedo, C., de Castro, M. M. G., & Combarro, J. (2012) · GuíaSalud eBooks · doi:10.46995/gpc_481 · Cited by 2 · see citing works
Coping and resilience as predictors of adolescent self-harm
van der Wal, W. (2017) · Cited by 2 · see citing works
Bethell, J. (2012) · TSpace (University of Toronto) · Cited by 2 · see citing works
Hennefield, L., Donohue, M. R., Hoyniak, C. P., Whalen, D. J., Thompson, R. J., Tillman, R., Luby, J. L., & Barch, D. M. (2025) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.70040 · Cited by 1 · see citing works
Gladstone, T. R. G., Feinstein, R. T., Fitzgibbon, M., Schiffer, L. A., Berbaum, M. L., Lefaiver, C. A., Pössel, P., Diviak, K. R., Wang, T., Knepper, A. K., et al. (2022) · Contemporary Clinical Trials · doi:10.1016/j.cct.2022.106763 · Cited by 2 · see citing works
Asarnow, J. R., Clarke, G. N., Miranda, J. M., Edelmann, A. C., Sheppler, C. R., Firemark, A. J., Zhang, L., Babeva, K. N., Venables, C. W., & Comulada, W. S. (2023) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2023.2208382 · Cited by 1 · see citing works
“…and work status, living situation, gender identity, sexual orientation, parent education and employment, access to guns (Hepburn et al., 2007), life stress (UCLA Life Stress Questionnaire, adapted from Asarnow et al., 2008), and parent/family history of suicide/SAs (Weissman et al., 2000).”
BackgroundBallard, E. D. (2012) · Cited by 1 · see citing works
Gender stereotypes among Spanish university students about psychosocial risks in childhood
Sánchez‐Sandoval, Y., Vizcaya, E., Melero, S., & Verdugo, L. (2019) · IJERI International Journal of Educational Research and Innovation · doi:10.46661/ijeri.3655 · Cited by 1 · see citing works
Suicide and Substance Abuse in Adolescents
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“1 CHAPTER 1 INTRODUCTION The termination of a romantic relationship is an anxiety-inducing experience that can result in a variety of negative mental and physical health consequences (Asarnow et al., 2008; Davis et al., 2003; Gottman, 1994; Kriegbaum, Christensen, Andersen, Oslen, Lund, 2013; Monroe et al., 1999; Sbar…”
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Depressive Disorders in Children and Adolescents with Neurologic Disorders
Caplan, R. (2012) · Wiley eBooks · doi:10.1002/9781118348093.ch7
Emergency Psychiatry: Suicide assessments
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Depression, Bipolar Disorder, and Suicidal Behavior in Children
Freed, R. D., Chan, P. T., Langer, D. A., & Tompson, M. C. (2013) · Wiley eBooks · doi:10.1002/9781118528563.wbcbt35
Der unklare, z. B. desorientierte Notfallpatient
Kölch, M. G., & Plener, P. L. (2013) · Springer eBooks · doi:10.1007/978-3-642-37309-1_24
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Suicide in Children and adolescents: a review of articles about this topic
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“In addition to the tragic deaths by suicide among youth, non-fatal suicide attempts and suicide-related ideation are leading causes of psychiatric hospitalization among children and adolescents, and constitute severe and often chronic impairment [30].”
BackgroundKinder- und jugendpsychiatrische Notfälle
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Training Mental Health Providers to Prevent Teen Suicide Using Evidence-Based Approaches
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Der unklare, z. B. desorientierte Notfallpatient
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Appendix 2.References and Suggestions for Further Reading
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- Authors
- Asarnow, J. R., Baraff, L. J., Berk, M., Grob, C., Devich-Navarro, M., Suddath, R., Piacentini, J., & Tang, L.
- Affiliations
- University of California, Los Angeles (US)
- Corresponding author
- Asarnow, Joan Rosenbaum
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2008-08
- Volume
- 47
- Issue
- 8
- Pages
- 958-966
- ISSN
- 0890-8567 (ISSN-L)
- OpenAlex
- W2015780041
- Cited by
- 106
- References
- 40
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 3 · 2023: 5 · 2022: 6 · 2021: 4 · 2020: 11 · 2019: 5 · 2018: 7 · 2017: 6 · 2016: 5 · 2015: 5 · 2014: 10 · 2013: 6 · 2012: 9
- FWCI
- 6.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5p30mh068639-05)
- U.S. Public Health Service (CCR921708)
- National Institute of Mental Health (P30-MH068639)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Social Sciences › Health › Gun Ownership and Violence Research
- Keywords
- youth suicide, suicide attempts, suicidal ideation, repeated suicide attempts, pediatric emergency department, depression, romantic breakup, suicide exposure, pregnancy, environmental stress, male suicide, undertreatment, suicide prevention
- MeSH terms
- Adolescent, Child, Depression, Emergency Medical Services, Female, Humans, Interpersonal Relations, Love, Male, Pediatrics, Recurrence, Suicide, Attempted, Incidence, Prevalence
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