Issue 6, 2006R

Disposition of Emergency Department Visits for Drug-Related Suicide Attempts by Adolescents: 2004

Suicide in adolescence is a major public health problem. According to the Centers for Disease Control and Prevention (CDC), 9 percent of students in public and private high schools in 2003 had attempted suicide in the past year, and 3 percent of students reported needing medical treatment after their suicide attempt.¹

Given approximately 15.6 million high school students in the United States, this translates to over 1.3 million suicide attempts, thousands of which would have been handled in hospital emergency departments (EDs).² Therefore, EDs are an important setting for interventions, as well as for referrals and medical treatment of suicidal adolescents.

This report uses 2004 data from the Drug Abuse Warning Network (DAWN) to examine the outcome (i.e., disposition) of ED visits caused by drug-related suicide attempts by persons aged 12 to 17. DAWN is a public health surveillance system that measures drug-related ED visits in the United States. Data are collected from a nationally representative sample of short-term, general, non-Federal hospitals across the Nation. Specialty hospitals, including children's hospitals, are not included in the DAWN sample.

To be a DAWN case, the ED visit must have involved a drug, either as the direct cause of the visit or as a contributing factor. For each drug-related ED visit, information is gathered about the number and types of drugs involved, including illicit drugs, prescription and over-the-counter medications, nutritional supplements, inhalants, and alcohol. DAWN also collects demographic information about the patients, their diagnoses, and their disposition after discharge from the ED.

An examination of the disposition of ED visits caused by drug-related suicide attempts can provide insights into the severity of the attempts and help to identify the need for services to address adolescent suicide attempts.

In 2004, there were an estimated 21,584 ED visits associated with drug-related suicide attempts among persons aged 12 to 17 in the United States. These suicide attempts involved an average of 1.7 drugs, with more than half (57 percent) of the suicide attempts involving only one drug, and 5 percent involving four or more drugs. The majority of the adolescent patients received follow-up medical care in the same hospital or were transferred to another health care facility after discharge from the ED (Table 1).

In 2004, DAWN received no reports of deaths in the ED for drug-related suicide attempts involving adolescents. However, this is based solely on ED records, which do not include patients who died before coming to the ED or after leaving the ED.

An estimated 6,358 (29 percent) of adolescents whose suicide attempt involved drugs were released after treatment in the ED (Table 1). Of these, 85 percent were discharged home, while 15 percent were referred to a detoxification/substance abuse treatment program.

On average, 1.7 drugs were involved in the suicide attempts of adolescent patients who were treated and released. Half of these suicide attempts involved at least one pain medication, most frequently a nonsteroidal anti-inflammatory drug (NSAID) (34 percent), such as ibuprofen, or a pain medication containing acetaminophen (24 percent) (Table 2).

Psychotherapeutic medications were involved in 43 percent of cases that were treated and released. Antidepressants were the most frequent, involved in 24 percent of the visits. The DAWN data do not distinguish which of the patients had been prescribed antidepressants to treat preexisting depression and other mental health problems.

Additionally, 8 percent of the cases that were treated and released involved at least one illicit drug.

In an estimated 8,595 (40 percent) of the drug-related suicide attempts, the patient was admitted to the hospital upon discharge from the ED (Table 1). Approximately 40 percent of these patients were moved to a psychiatric unit.

The suicide attempts of adolescents who were admitted to the hospital involved an average of 1.7 drugs. Pain relievers were implicated in approximately 60 percent of these cases. These were primarily NSAIDs (29 percent) and pain medications containing acetaminophen (25 percent) (Table 2). Pain medications containing opioids are obtainable only by prescription. Pain medications containing acetaminophen or ibuprofen, while widely available, can be toxic if misused.

Psychotherapeutic drugs were implicated in 28 percent of the suicide attempts by adolescents who were admitted to the hospital. Antidepressants were the most frequently used psychotherapeutic, involved in 17 percent of these suicide attempts.

Approximately 23 percent of the suicide attempt cases that were admitted involved an illicit substance. Alcohol was involved in most of these visits, almost always used in combination with another drug. The interaction between alcohol and medications can increase the medication's toxicity, especially if it is a central nervous system depressant.³

Other dispositions accounted for an estimated 6,631 (31 percent) of the adolescent suicide-related ED visits that involved drugs. Almost all (99 percent) of these patients were transferred to another health care facility (Table 1).

Patients transferred to another facility. Thirty percent of adolescent drug-related suicide attempt cases were transferred to another health care facility after discharge from the ED. The suicide attempts of these patients involved, on average, 1.6 drugs. Pain medications were involved in half of these visits. The prevalence of pain medications among transferred patients was similar to the prevalence among patients with other dispositions. The most commonly involved pain medications were the NSAIDs (31 percent), followed by the acetaminophen/combination drugs (14 percent) (Table 2).

Psychotherapeutic drugs were involved in 31 percent of the suicide attempts by adolescent patients who were transferred to another medical facility. The anti-anxiety/sedative medications were involved in about half as many visits as the antidepressants (17 percent).

Approximately 23 percent of all the suicide-related ED visits that were transferred to another facility involved at least one illicit substance, primarily alcohol (16 percent).