(PS13-37) The Association Between Recency of Suicide Attempt and Reattempt in Adult Emergency Department Patients

Suicide is a leading cause of death for adults. Early identification of risk is important because the majority of patients who die by suicide visit a healthcare provider weeks prior to their death. However, managing patients with suicidal thoughts and behaviors (STBs) in medical settings can be challenging due to time and staffing constraints. Thus, determining which individuals are most at-risk is crucial for allocation of mental health resources. Among known risk factors, a prior history of suicidal behavior is one of the strongest predictors of future suicide attempt. Research demonstrates that 1/3 of patients who screen positive for suicide risk report a past suicide attempt with no current ideation. However, there are limited data on how recency of the prior attempt is associated with risk of future attempt. Knowing how a past attempt’s timeframe impacts risk can help clinicians determine disposition and treatment for at-risk individuals.

This study aimed to describe the association between recency of a prior suicide attempt and reattempt 1 year post-discharge in adults presenting to an emergency department (ED).

This is a secondary analysis of data from the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study, which recruited participants from 8 US emergency departments from August 2010 to November 2013. The present sample included adult patients who reported a suicide attempt at or prior to index ED visit and were assessed for reattempt 52 weeks post-discharge. Demographics (sex, race/ethnicity, age) were self-reported by participants, and time of most recent suicide attempt was obtained using the Patient Safety Screener, a validated suicide risk screener for ED settings. The presence of a reattempt was determined from follow-up telephone interviews and medical record review. Binary logistic regressions, controlling for demographics and study phase, assessed the relationship between recency of a prior attempt and reattempt.

Data were analyzed from 417 patients aged 18-93 years old (mean [SD] = 36.3 [12.7] years, 59.2% female, 66.4% non-Hispanic white) who had a prior suicide attempt, reported its recency, and were assessed for reattempt. At baseline, 33.3% (139/417) had a prior attempt within the last 24 hours, 14.6% (61/417) within the last month, 9.6% (40/417) within the past 6 months, and 42.4% (177/417) over 6 months ago. 19.6% (83/417) of patients reattempted suicide during the 52-week follow-up period. Compared to those whose last attempt was over 6 months ago, participants who attempted in the month prior to index visit had 2.6 times (95% CI: 1.3–5.2, z = 2.7, p < 0.01) higher odds of reattempting within the following year.

Participants with a prior attempt within the past month were more likely to reattempt post-discharge compared to those whose attempt was more than 6 months prior to index visit. This suggests that ED patients presenting with an attempt as recent as 1 month may require more extensive intervention to prevent reattempt post-discharge. These findings could impact suicide risk clinical pathways by providing risk parameters for managing patients who screen positive with a past suicide attempt history. Future studies should examine how recency of STBs jointly impact risk of a future attempt.