June 16, 2011

Trends in Emergency Department Visits for Drug-Related Suicide Attempts among Males: 2005 and 2009

Suicide ranks as the seventh leading cause of death among males.¹ In 2007, males committed suicide at nearly 4 times the rate of females and represented 79.0 percent of all U.S. suicides.² Individuals with substance dependence or abuse were more than 3 times more likely to report serious thoughts of suicide.³ Because previous suicide attempts are one of the strongest predictors for completed suicides,⁴ examining data from drug-related emergency department (ED) visits involving suicide attempts can be one way to identify particular patterns in suicidal behaviors among men who are at the highest risk for taking their lives. Such information can be used to inform prevention and treatment efforts targeting this population.

DAWN is a public health surveillance system that monitors drug-related ED visits in the United States. To be a DAWN case, an ED visit must have involved a drug, either as the direct cause of the visit or as a contributing factor. DAWN data can be used to examine ED visits for drug-related suicide attempts. Although DAWN includes only suicide attempts that involve drugs, these attempts are not limited to drug overdoses. If there is drug involvement in a suicide attempt by other means (e.g., if a patient cuts his or her wrists while under the influence of marijuana), the case is included as drug related. Excluded are suicide attempts with no drug involvement and suicide-related behaviors other than actual attempts (e.g., suicidal ideation or suicidal thoughts); also excluded are suicide attempts involving alcohol only for patients aged 21 or older. This issue of The DAWN Report describes trends in ED visits for drug-related suicide attempts among males in 2005 and 2009.

Between 2005 and 2009, younger males (those aged 21 to 34) experienced a statistically significant increase of 54.6 percent in the number of visits for drug-related suicide attempts (from 19,024 to 29,407 visits) (Figure 1). For all age groups combined, the difference between 2005 and 2009 was not significant. In 2009, there were 77,971 ED visits for drug-related suicide attempts among males.

Figure 1. Emergency Department (ED) Visits for Drug-Related Suicide Attempts among Males, by Age Group: 2005 and 2009

The number of ED visits for suicide attempts involving alcohol in combination with other drugs significantly increased by 1.5 times from 19,081 visits in 2005 to 28,873 visits in 2009 (Table 1); however, the number of visits involving each of most other types of illicit drugs did not change significantly during this period of time. An exception is visits involving stimulants, which decreased 63.2 percent (from 3,744 visits in 2005 to 1,380 visits in 2009).

Between 2005 and 2009, the number of drug-related ED visits among males involving pharmaceutical drugs increased by 41.9 percent (from 49,816 visits in 2005 to 70,671 visits in 2009) (Table 1). In particular, several types of pharmaceuticals showed striking increases during this period. For example, the number of visits involving the narcotic pain relievers hydrocodone and oxycodone more than doubled between these years (146.8 and 117.2 percent, respectively). At the same time, the number of visits made by males involving lorazepam—a type of benzodiazepine—increased by 170.3 percent.

Among males aged 12 to 20, the number of visits that involved anticonvulsants showed a significant difference between 2005 (361 visits) and 2009 (1,319 visits).⁵ This represents a 265.5 percent change between these years (Table 2).

Among males aged 21 to 34, the number of visits involving pain relievers showed a statistically significant increase of 60.2 percent (from 7,185 to 11,509 visits). Likewise, there were also differences for this age group with respect to drugs that treat symptoms related to mental health problems, such as depression or anxiety. For example, the number of visits involving antidepressants increased 155.2 percent (from 1,519 to 3,876 visits), and the number of visits involving drugs that treat anxiety or insomnia increased 93.4 percent (from 5,018 to 9,706 visits).

Among males aged 35 to 49, the number of visits involving narcotic pain relievers almost doubled between 2005 and 2009 (from 2,380 to 4,270 visits). In particular, the number of visits involving hydrocodone and oxycodone each increased almost threefold (from 691 to 2,480 visits for hydrocodone, and from 486 to 1,776 visits for oxycodone). Among males aged 50 or older, the number of visits involving narcotic pain relievers almost tripled from 2005 to 2009 (from 882 to 2,589 visits).

The data in this report suggest that approaches for addressing drug-related suicide attempts among men may vary based on age group. For adolescents, many sources recommend that physicians annually ask about thoughts or behaviors that may indicate risk for suicide. Specialized screening instruments have been developed for this purpose.⁶ The overall increase in the number of ED visits for drug-related suicide attempts among males aged 21 to 34—an age group for which suicide ranks as the third leading cause of death and for which the prevalence of substance misuse is at its highest^1,7 —suggests that young adult males identified as at risk may benefit from continued efforts to integrate mental health services into substance abuse treatment. This is also the same age group that has had significant increases in suicide attempts involving antidepressants and medications that treat insomnia and anxiety.

Symptoms of depression can accompany declining physical health among older adults. For this reason, older men who use medications such as pain relievers and cardiovascular system medications also can be at high risk for mental health problems. This may be especially true for men aged 75 or older—an age at which suicide rates are highest among men.² As a part of routine primary care, health care providers can screen for depression, provide counseling, and/or refer patients and their families to educational and community resources. For additional information about suicide screening and prevention, see the U.S. Preventive Services Task Force publication Screening for Suicide Risk: Recommendation and Rationale.⁸

This page was last updated on December 11, 2010.

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