Factors Associated With Revisiting the Emergency Department due to Suicidal Behavior in Children and Adolescents

Suicide is a major public health concern with a significant global impact. Among children and adolescents, an increasing incidence of suicidal behavior is being observed. Several studies have noted an increase in the number of emergency department (ED) consultations involving children and adolescents presenting with self-injurious thoughts and behaviors (SITB). However, few studies have yet described risk factors associated with these repeated visits. Our sample included all patients under 18 years of age who visited the Child and Adolescent Mental Health ED at Hospital Universitario 12 de Octubre between January 2, 2022, and November 30, 2023. A baseline interview was conducted by an attending psychiatrist during the patient's first emergency visit, followed by a review of their digital medical records 6 months later by the hospital's clinical staff. A total of 713 patients were treated in the ED during the study period, of whom 429 (60.16%) presented with suicidal behavior. Within 6 months of the initial ED visit, 25.4% of patients returned due to SITB. Specifically, 21.7% of those who initially attended for SITB returned for the same reason. Among patients who initially presented with suicidal ideation or suicide attempts, 25.8% and 25.3%, respectively, returned within 6 months. The variables independently associated with returning to the ED for SITB after the initial visit were nonheterosexual sexual orientation (odds ratio [OR]=2.10; 95% CI, 1.14-3.87) and prior SITB (OR=2.14; 95% CI, 1.27-3.60). In our study, we found that a significant number of children and adolescents who come to the ED for SITB return for the same reason within 6 months. There is also a certain amount of switching between different types of SITB consultations, particularly from ideation to attempt. This should alert us to the significant recurrence of these consultations and the fact that mental health resources continue to be insufficient to address these behaviors.