One in nine high-risk teenagers attempted suicide within three months of ED visit

More than 1 in 10 adolescents who screened positive for suicide risk in an emergency department attempted suicide within three months, with hopelessness, recent attempts and weak social ties among the warning signs.

A new analysis of adolescents who screened positive for suicide risk in emergency departments found that more than 1 in 10 went on to attempt suicide within three months, underscoring how fragile the period after an ED visit can be for young people in crisis. The study, published online in the Annals of Emergency Medicine, was led by Ashley A. Foster of the University of California, San Francisco, and examined whether certain clinical and social factors could help identify which teenagers were most likely to attempt suicide again after leaving the ED.

The researchers reviewed data from 2,085 adolescents aged 12 to 17 who had positive results on the Ask Suicide-Screening Questions tool during the Pediatric Emergency Care Applied Research Network’s ED-STARS studies. These participants were assessed during the index ED visit, then followed through interviews and chart review. Within three months, 11.6% had made a suicide attempt and 19.9% had returned to the ED or been hospitalised for a mental health problem.

Several features stood out as warning signs. A suicide attempt in the month before the ED visit, earlier mental health hospitalisation, a history of non-suicidal self-injury and feelings of hopelessness during the visit were all linked to a greater chance of another attempt. The analysis also found that boys had lower adjusted odds of subsequent attempts than girls, while stronger social connectedness appeared to reduce risk. Prior mental health hospitalisation, a recent suicide attempt and hopelessness were also associated with a mental health-related return to the ED or hospital admission within three months.

The findings fit with earlier research showing that suicide screening in emergency departments can identify young people at elevated risk, even when they arrive for non-psychiatric complaints. Earlier studies in the field found that screening tools could detect adolescents with severe suicidal thoughts or a recent attempt, and prospective work has shown that a meaningful share of teenagers go on to engage in suicidal behaviour in the weeks after an ED visit. Together, that evidence supports the ED as a critical point for intervention rather than simply a place for immediate stabilisation.

The new study’s authors argued that hopelessness and social connectedness are modifiable factors, and said those risks should be shared with families and outpatient or school-based mental health providers. They suggested that ED-based interventions aimed at reducing hopelessness and strengthening supportive relationships could improve care for young people who screen positive. But the researchers also noted important limits: the sample included only English-speaking adolescents, came largely from academic paediatric emergency departments in urban areas, and was enriched for suicide risk, so the results may not apply to all emergency patients.