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February 28, 2020

Emergency Department Visits for Suicidal Thoughts and Self-harm on the Rise

Author Affiliations
  • 1Consulting Editor, JAMA Health Forum and JAMA
JAMA Health Forum. 2020;1(2):e200274. doi:10.1001/jamahealthforum.2020.0274

Life expectancy in the US rose in 2018 for the first time in 4 years, according to a recent report from the National Center for Health Statistics at the US Centers for Disease Control and Prevention (CDC). However, one leading cause of death that has remained stubbornly resistant to improvement is death by suicide, which has continued to climb over the past 20 years.

In 2018, 48 344 people died by suicide, compared with 47 173 in 2017. The 2018 suicide rate, 14.2 deaths per 100 000 people, has increased 35% since 1999.

But as researchers note in a recent article in the CDC’s Morbidity and Mortality Weekly Report, such deaths signal a larger problem. Suicidal thoughts and nonsuicidal, self-directed violence, or self-harm—both of which are risk factors for suicide—have sharply increased in the 2 years between January 2017 and December 2018, as reflected in emergency department visits for those causes.

Analysis of data from the CDC’s National Syndromic Surveillance Program showed that during the 2-year study period, approximately 2.1 million of 163 million emergency department visits by individuals aged 10 years or older involved suicidal thoughts, self-harm, or both. The rate of visits for these reasons increased 25.5% during that period (22.7% for women and girls and 27.6% for men and boys), with a mean increase of 1.2% per month.

Emergency department visits for suicidal thoughts, self-harm, or both over the 2-year study period rose significantly among all age groups of women and girls, except among those aged 20 to 39 years, and among all age groups of men and boys. The largest increases occurred among boys aged 10 to 19 years (62.3%) and men 60 years or older (36.7%), followed by girls aged 10 to 19 years (33.7%) and women 60 years or older (29.0%). Other trends in emergency department visits for suicidal thoughts, self-harm, or both included a seasonal pattern for people of both sexes aged 10 to 19 years, with the lowest proportion of visits occurring during summer months, and geographic variation, with the largest increases in visit rates during the study period observed among men and boys in the Midwest (38.7%) or Southeast (33.5%) and women and girls in the Midwest (28.7%), although rates were consistently highest in the West.

The suicide rate in the US is higher relative to 10 other high-income countries, a fact highlighted in a Commonwealth Fund report released on January 30, “US Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes.” “Elevated suicide rates may indicate a high burden of mental illness; socioeconomic variables are also a factor,” the report noted, adding that the US “has seen an uptick in ‘deaths of despair’ in recent years, which include suicides and deaths related to substance use, including overdoses.”

The authors of the Morbidity and Mortality Weekly Report article noted that emergency department syndromic surveillance data “can provide timely trend information and can support more targeted and prompt public health investigation and response.” They pointed to the CDC’s “Preventing Suicide: A Technical Package of Policy, Programs, and Practices” as a resource with strategies designed to help states and communities put suicide prevention efforts in place.

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