Objective: In medical settings, 1/3 of patients who screen positive for suicide risk will solely endorse a past suicide attempt without current ideation, over-utilizing resources that could benefit higher risk patients. However, little is known about risk of future attempt based on recency of past attempt. This presentation will describe findings on suicide attempts post-discharge following suicide risk screening and brief interventions in the emergency department (ED). Findings can be used to revise a 3-tiered suicide risk screening clinical pathway to make suicide prevention in medical settings more feasible.
Methods: Secondary analyses of datasets from two large ED studies were performed. Samples included pediatric (12-17 years) and adult (18-93 years) patients with a past suicide attempt and its recency at index visit. Pediatric patients received a follow-up call 3 months post-discharge assessing if a reattempt occurred and adult patients received follow-up calls up to 52 weeks. Past attempt and recency were determined via questions from the Ask Suicide-Screening Questions and Columbia-Suicide Severity Rating Scale in pediatric patients and the Patient Safety Screener in adult patients.
Results: These secondary analyses included 352 pediatric participants (70% cisgender female, 59% White, mean[SD] age = 15.3[1.5] years) and 417 adult patients (59.2% female, 66.4% non-Hispanic white, mean[SD] age = 36.3 [12.7] years). 17.3% (61/352) of pediatric patients and 19.9% (83/417) of adult patients reattempted suicide post-discharge. For pediatric patients, those who attempted suicide within 1 week before their index visit had 4.8 times (95%CI: 1.7 - 16.2, p < 0.01) higher odds of reattempting at 3-month follow-up compared to those whose previous attempt was more than a year before the index visit. For adult patients, those who attempted in the month prior to index visit had 2.6 times (95% CI: 1.3–5.2, p < 0.01) higher odds of reattempting within the following year compared to those who attempted over 6 months ago.

Conclusion

Patients that have a past suicide attempt greater than one year ago for youth, or more than six months for adults, without current suicidal ideation may not require further assessment during ED visits, freeing up resources for patients at greater risk. These findings can impact suicide risk clinical pathways by providing risk parameters for managing patients who screen positive with a past attempt history.