PATIENTS WITH DRUG-RELATED EMERGENCY DEPARTMENT VISITS INVOLVING SUICIDE ATTEMPTS WHO LEFT AGAINST MEDICAL ADVICE

PATIENTS WITH DRUG-RELATED EMERGENCY DEPARTMENT VISITS INVOLVING SUICIDE ATTEMPTS WHO LEFT AGAINST MEDICAL ADVICE

Report Highlights Statistics on Patients With Drug-Related Emergency Department Visits Involving Suicide Attempts Who Left Against Medical Advice

According to the Drug Abuse Warning Network, emergency department (ED) visits involving drug-related suicide attempts increased 41 percent from 2004 to 2011, from an estimated 161,586 visits to 228,366 visits. Patients who left the ED before their treatment was completed may have missed a critical opportunity to receive medical follow-up.

In Brief

• According to the Drug Abuse Warning Network, emergency department (ED) visits involving drug-related suicide attempts increased 41 percent from 2004 to 2011, from an estimated 161,586 to 228,366 visits.
• There was a total of about 1.5 million ED visits involving drug-related suicide attempts between 2004 and 2011.     
• Combined 2004 to 2011 data indicate that among the ED visits involving drug-related suicide attempts, 5,396 ED visits (less than 1 percent) ended with the patient leaving the ED against medical advice.     
• Just over half (54 percent) of the ED visits involving drug-related suicide attempts that ended with the patient leaving against medical advice involved males, and over a quarter (29 percent) involved patients between the ages of 35 and 44.

PATIENTS WITH DRUG-RELATED EMERGENCY DEPARTMENT VISITS INVOLVING SUICIDE ATTEMPTS WHO LEFT AGAINST MEDICAL ADVICE

AUTHORS

Elizabeth H. Crane, Ph.D., M.P.H.

INTRODUCTION

Suicide attempts and death by suicide are significant public health issues in the United States. In 2014, more than 1.1 million adults aged 18 years or older in the United States (0.5 percent) attempted suicide in the past year.¹ A history of previous suicide attempts remains one of the most important risk factors for death by suicide.² As many as 39 percent of people who die by suicide had been seen in an emergency department (ED) in the year before their death.^2,3  For people who survive a suicide attempt, the period after an ED visit is a time of high risk for another suicide attempt. Reductions in the tragedy of subsequent suicide deaths, however, have been shown through engaging patients in timely treatment and providing follow-up services after discharge from the ED.^4,5 Adults who received medical attention resulting from a suicide attempt are more likely to receive mental health treatment compared to those who did not receive medical attention.⁶ Thus, in addition to attending to immediate physical health issues, ED care represents an important opportunity to assess the patient's mental health needs and provide follow-up resources at a particularly critical juncture in his or her care. The full complement of services, however, may be delivered only if the patient completes the ED visit before being discharged, admitted, or transferred.

The Drug Abuse Warning Network (DAWN) was a public health surveillance system that monitored drug-related ED visits in the United States. DAWN can be used to examine ED visits involving drug-related suicide attempts. To be a DAWN case, an ED visit must have involved a drug, either as the direct cause of the visit or as a contributing factor. Data were collected on illicit drugs, prescription and over-the-counter medications, and dietary supplements. Data were also collected for visits involving alcohol combined with other drugs and, for patients aged 20 or younger, visits where alcohol was the only substance involved in the visit. Although DAWN included only suicide attempts that involved drugs, those attempts were not limited to drug overdoses. If drugs were involved in a suicide attempt by other means (e.g., self-inflicted wounds while under the influence of marijuana), the case was included as drug related. Excluded were suicide attempts with no drug involvement and suicide-related behaviors other than actual attempts (e.g., suicidal ideation, suicidal thoughts). This issue of The CBHSQ Report highlights the characteristics of ED visits involving drug-related suicide attempts among people aged 12 or older from 2004 to 2011. Unless otherwise noted, all comparisons described as increases, decreases, or differences are statistically significant at the .05 level.