Anne E Rhodes1,2,3,4, Mark Sinyor1,5,6, Michael H Boyle3,4,7, Jeffrey A Bridge8,9, Laurence Y Katz10, Jennifer Bethell11, Amanda S Newton12, Amy Cheung1,5,6, Kathryn Bennett3,4,7, Paul S Links4, Lil Tonmyr13, Robin Skinner13. 1. 1 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario. 2. 2 Institute for Clinical Evaluative Sciences, Toronto, Ontario. 3. 3 Offord Centre for Child Studies, Hamilton, Ontario. 4. 4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario. 5. 5 Sunnybrook Health Sciences Centre, Toronto, Ontario. 6. 6 Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario. 7. 7 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario. 8. 8 Center for Suicide Prevention and Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA. 9. 9 Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA. 10. 10 Child and Adolescent Mental Health, Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba. 11. 11 The Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario. 12. 12 Department of Pediatrics, University of Alberta, Edmonton, Alberta. 13. 13 Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa.
Abstract
OBJECTIVE: We estimate associations between emergency department (ED) diagnoses and suicide among youth to guide ED care. METHOD: This ED-based case-control study used data from the Office of the Chief Coroner and all EDs in Ontario, Canada. Cases ( n = 697 males and n = 327 females) were aged 10 to 25 years who died by suicide in Ontario between April 2003 and March 2014, with an ED contact in the year before their death. Same-aged ED-based controls were selected during this time frame. Crude and adjusted odds ratios (aORs) and 95% confidence intervals were calculated. RESULTS: Among youth diagnosed with a mental health problem at their most recent ED contact (41.9% cases, 5% controls), suicide was elevated among nonfatal self-inflicted: 'other' injuries, including hanging, strangulation, and suffocation in both sexes (aORs > 14); cut/pierce injuries in males (aOR > 5); poisonings in both sexes (aORs > 2.2); and mood and psychotic disorders in males (aORs > 1.7). Among those remaining, 'undetermined' injuries and poisonings in both sexes (aORs > 5), 'unintentional' poisonings in males (aOR = 2.1), and assault in both sexes (aORs > 1.8) were significant. At least half of cases had ED contact within 106 days. CONCLUSIONS: The results highlight the need for timely identification and treatment of mental health problems. Among those with an identified mental health problem, important targets for suicide prevention efforts are youth with self-harm and males with mood and psychotic disorders. Among others, youth with unintentional poisonings, undetermined events, and assaults should raise concern.
OBJECTIVE: We estimate associations between emergency department (ED) diagnoses and suicide among youth to guide ED care. METHOD: This ED-based case-control study used data from the Office of the Chief Coroner and all EDs in Ontario, Canada. Cases ( n = 697 males and n = 327 females) were aged 10 to 25 years who died by suicide in Ontario between April 2003 and March 2014, with an ED contact in the year before their death. Same-aged ED-based controls were selected during this time frame. Crude and adjusted odds ratios (aORs) and 95% confidence intervals were calculated. RESULTS: Among youth diagnosed with a mental health problem at their most recent ED contact (41.9% cases, 5% controls), suicide was elevated among nonfatal self-inflicted: 'other' injuries, including hanging, strangulation, and suffocation in both sexes (aORs > 14); cut/pierce injuries in males (aOR > 5); poisonings in both sexes (aORs > 2.2); and mood and psychotic disorders in males (aORs > 1.7). Among those remaining, 'undetermined' injuries and poisonings in both sexes (aORs > 5), 'unintentional' poisonings in males (aOR = 2.1), and assault in both sexes (aORs > 1.8) were significant. At least half of cases had ED contact within 106 days. CONCLUSIONS: The results highlight the need for timely identification and treatment of mental health problems. Among those with an identified mental health problem, important targets for suicide prevention efforts are youth with self-harm and males with mood and psychotic disorders. Among others, youth with unintentional poisonings, undetermined events, and assaults should raise concern.
Entities:
Keywords:
adolescent; diagnoses; emergency health services; risk factors; sex distribution; suicide
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