A Comparison of Suicide Attempt Histories of Pediatric and Adult Medical Inpatients and Implications for Screening

Abstract

Objective

A suicide attempt is the most potent predictor of future suicidal behavior, yet little is known about how to manage and respond to reports of attempt histories in hospitalized medical patients. This study aims to describe the prevalence and characteristics of pediatric and adult medical inpatients who report a past suicide attempt.

Method

Participants were medical inpatients, aged 10–93 years, enrolled in two suicide risk screening instrument validation studies. Participants completed the Ask Suicide-Screening Questions (ASQ) and the Patient Health Questionnaire (PHQ).

Results

A total of 1324 medical inpatients (624 pediatric, 700 adult) completed the ASQ, with 114 participants (8.6%) reporting a past suicide attempt (51 pediatric; 63 adults). Comparing youth to adults, there was no significant difference between attempt rates (χ²=0.29, p = 0.59). Youth with a past attempt were significantly more likely to report past week suicidal ideation (OR = 28.22; 95% CI = 5.90, 135.06) and have a history of mental health care (OR = 9.11; 95% CI = 2.59–32.10), compared to those without a past attempt. Adults with a past attempt were significantly more likely to screen positive for depression, compared to those without attempt histories (OR = 5.00; 95% CI = 2.31–10.83).

Conclusions

Nearly 9% of hospitalized medical patients endorsed a past suicide attempt when screened. Since adolescence is a critical time for detecting suicide risk, screening that includes past suicidal behavior may be an important means to identify youth with recent suicidal thoughts. By assessing recency of suicide attempts in adults, medical settings may optimize the effectiveness of how positive suicide risk screens are managed.

HIGHLIGHTS

• Roughly 9% of medical patients reported a past suicide attempt when screened.

• Adolescence is a critical time for detecting suicide risk and intervening.

• Assessing past suicide attempts in adults can help with managing positive screens.

Keywords:

• Adult medical inpatients
• pediatric medical inpatients
• suicide attempt
• suicide risk screening

ACKNOWLEDGEMENTS

The authors would like to thank the following people who were instrumental to the success of the study, including Sandra McBee-Strayer, Mary Tipton, Emory Bergdoll, Jeanne Radcliffe, Eliza Lanzillo, Asher Siegelman, Elizabeth Ballard, Erina White, Don Rosenstein, Martine Solages, June Cai, Colin Harrington, Edwin Boudreaux, Paramjit Joshi, Stephen J. Teach, Sandra Rackley, Michael Lotke, Jichuan Wang, Adelaide Robb, Laura Nicholson, Nadirah Waites, Nicole Hedrick, Kerry Brodziak, Mariam Gregorian, Ian Stanley, Julian Lantry, William Booker, Michael Schoenbaum, Cristan Farmer, Sally Nelson, Patricia Ibeziako, Adam Rosenfeld, Janet Frazier, Louis French, Jared Smith, Keenan Withers, Samantha Chalker, Rumsha Hafeez, Amanda Hayes, Olla Elbasheer, Apoorva Deshpande, Mehreen Kahn, and all the patients, nurses, mental health and medical teams that helped make the study run smoothly. ClinicalTrials.gov Identifier (NCT number): NCT02140177. The views expressed in this abstract are those of the author and do not reflect the official policy of the National Institute of Mental Health, National Institute of Health, Department of Health and Human Services or Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

DATA AVAILABILITY STATEMENT

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.

Additional information

Funding

This research was supported in part by the Intramural Research Program of the NIMH (Annual Report Number ZIAMH002922).

Notes on contributors

Annabelle M. Mournet

Annabelle M. Mournet, BA, Office of the Clinical Director, National Institute of Mental Health, Bethesda, Maryland, USA.

Jeffrey A. Bridge

Jeffrey A. Bridge, PhD, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA; The Ohio State University, Columbus, Ohio, USA.

Abigail Ross

Abigail Ross, PhD, MSW, MPH, Boston Children’s Hospital, Boston, Massachusetts, USA; Fordham University, Graduate School of Social Service, The Bronx, New York, USA.

Daniel Powell

Daniel Powell, MD, Office of the Clinical Director, National Institute of Mental Health, Bethesda, Maryland, USA.

Deborah J. Snyder

Deborah J. Snyder, MSW, Office of the Clinical Director, National Institute of Mental Health, Bethesda, Maryland, USA.

Cynthia A. Claassen

Cynthia A Claassen, PhD, John Peter Smith Health Network, Fort Worth, Texas, USA.

Elizabeth A. Wharff

Elizabeth A. Wharff, PhD, MSW, Boston Children’s Hospital, Boston, Massachusetts, USA.

Maryland Pao

Maryland Pao, MD, Office of the Clinical Director, National Institute of Mental Health, Bethesda, Maryland, USA.

Lisa M. Horowitz

Lisa M. Horowitz, PhD, MPH, Office of the Clinical Director, National Institute of Mental Health, Bethesda, Maryland, USA.