Number of visits to the emergency department and risk of suicide: a population-based case-control study
Open accessAbstract
BACKGROUND: The aim was to study whether number of visits to emergency department (ED) is associated with suicide, taking into consideration known risk factors. METHODS: This is a population-based case-control study nested in a cohort. Computerized database on attendees to ED (during 2002-2008) was record linked to nation-wide death registry to identify 152 cases, and randomly selected 1520 controls. The study was confined to patients attending the ED, who were subsequently discharged, and not admitted to hospital ward. Odds ratio (OR) and 95% confidence intervals (CI) of suicide risk according to number of visits (logistic regression) adjusted for age, gender, mental and behavioral disorders, non-causative diagnosis, and drug poisonings. RESULTS: Suicide cases had on average attended the ED four times, while controls attended twice. The OR for attendance due to mental and behavioral disorders was 3.08 (95% CI 1.61-5.88), 1.60 (95% CI 1.06-2.43) for non-causative diagnosis, and 5.08 (95% CI 1.69-15.25) for poisoning. The ORs increased gradually with increasing number of visits. Adjusted for age, gender, and the above mentioned diagnoses, the OR for three attendances was 2.17, for five attendances 2.60, for seven attendances 5.97, and for nine attendances 12.18 compared with those who had one visit. CONCLUSIONS: Number of visits to the ED is an independent risk factor for suicide adjusted for other known and important risk factors. The prevalence of four or more visits was 40% among cases compared with 10% among controls. This new risk factor may open new venues for suicide prevention.
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Research outside the US indicates emergency room visits may be twice as frequent among people who die by suicide, and a rising count of emergency room visits is an independent risk factor.
“Evidence from outside the US has shown that emergency room visits may occur twice as often for individuals who die by suicide, and that an increasing number of emergency room visits is an independent risk factor.17”
From Variation in patterns of health care before suicide: a population case-control study. (2019) · cites this paper as [17]
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Variation in patterns of health care before suicide: a population case-control study.
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- Authors
- Kvaran, R. B., Gunnarsdottir, O. S., Kristbjornsdottir, A., Valdimarsdottir, U. A., & Rafnsson, V.
- Affiliations
- National University Hospital of Iceland (IS)
- University of Iceland (IS)
- Venue
- BMC Public Health
- Published
- 2015-03-07
- Volume
- 15
- Issue
- 1
- Pages
- 227-227
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC4361138
- OpenAlex
- W1964135373
- Cited by
- 22
- References
- 28
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 5 · 2018: 2 · 2016: 1 · 2015: 2
- FWCI
- 2.07
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Hirsla (Landspítali University Hospital) (submittedVersion)
- Funders
- Landspítali Háskólasjúkrahús
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- suicide, emergency department visits, suicide risk factors, mental and behavioral disorders, drug poisoning, suicide prevention
- MeSH terms
- Adult, Age Factors, Aged, Mental Disorders, Emergency Service, Hospital, Female, Hospitalization, Humans, Male, Middle Aged, Patient Discharge, Risk, Risk Factors, Sex Factors, Suicide, Prevalence, Logistic Models, Odds Ratio, Case-Control Studies, Drug-Related Side Effects and Adverse Reactions
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