TY - JOUR
T1 - Emergency Department Visits for Suicidal Ideation and Self-Harm in Rural and Urban Youths
AU - Hoffmann, Jennifer A.
AU - Hall, Matt
AU - Lorenz, Doug
AU - Berry, Jay G.
N1 - Funding Information:
Supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) Children and Youth with Special Health Care Needs Research Network (UA6MC31101, to J.B.) and by the US Agency for Healthcare Research and Quality (5K12HS026385-03, to J.H.). This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US Government. The authors declare no conflicts of interest.
Funding Information:
Supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) Children and Youth with Special Health Care Needs Research Network (UA6MC31101, to J.B.) and by the US Agency for Healthcare Research and Quality (5K12HS026385-03, to J.H.). This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US Government. The authors declare no conflicts of interest.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/11
Y1 - 2021/11
N2 - Objectives: To compare emergency department (ED) visit rates for suicidal ideation and/or self-harm among youth by urban-rural location of residence. Study design: This is a retrospective analysis of ED visits for suicidal ideation and/or self-harm by youths aged 5-19 years (n = 297 640) in the 2016 Nationwide Emergency Department Sample, a representative sample of all US ED visits. We used weighted Poisson generalized linear models to compare population-based visit rates by urban–rural location of patient residence, adjusted for age, sex, and US Census region. For self-harm visits, we compared injury mechanisms by urban-rural location. Results: Among patients with ED visits for suicidal ideation and/or self-harm, the median age was 16 years, 65.9% were female, 15.9% had a rural location of patient residence, and 0.1% resulted in mortality. The adjusted ED visit rate for suicidal ideation/or and self-harm did not differ significantly by urban-rural location. For the subset of visits for self-harm, the adjusted visit rate was significantly higher in small metropolitan (adjusted incidence rate ratio [aIRR], 1.39; 95% CI, 1.01-1.90), micropolitan (aIRR, 1.46; 95% CI, 1.10-1.93), and noncore areas (aIRR, 1.39; 95% CI, 1.03-1.87) compared with large metropolitan areas. When stratified by injury mechanism, ED visit rates for self-inflicted firearm injuries were higher among youths living in rural areas compared with those in urban areas (aIRR, 3.03; 95% CI, 1.32-6.74). Conclusions: Compared with youths living in urban areas, youths living in rural areas had higher ED visit rates for self-harm, including self-inflicted firearm injuries. Preventive approaches for self-harm based in community and ED settings might help address these differences.
AB - Objectives: To compare emergency department (ED) visit rates for suicidal ideation and/or self-harm among youth by urban-rural location of residence. Study design: This is a retrospective analysis of ED visits for suicidal ideation and/or self-harm by youths aged 5-19 years (n = 297 640) in the 2016 Nationwide Emergency Department Sample, a representative sample of all US ED visits. We used weighted Poisson generalized linear models to compare population-based visit rates by urban–rural location of patient residence, adjusted for age, sex, and US Census region. For self-harm visits, we compared injury mechanisms by urban-rural location. Results: Among patients with ED visits for suicidal ideation and/or self-harm, the median age was 16 years, 65.9% were female, 15.9% had a rural location of patient residence, and 0.1% resulted in mortality. The adjusted ED visit rate for suicidal ideation/or and self-harm did not differ significantly by urban-rural location. For the subset of visits for self-harm, the adjusted visit rate was significantly higher in small metropolitan (adjusted incidence rate ratio [aIRR], 1.39; 95% CI, 1.01-1.90), micropolitan (aIRR, 1.46; 95% CI, 1.10-1.93), and noncore areas (aIRR, 1.39; 95% CI, 1.03-1.87) compared with large metropolitan areas. When stratified by injury mechanism, ED visit rates for self-inflicted firearm injuries were higher among youths living in rural areas compared with those in urban areas (aIRR, 3.03; 95% CI, 1.32-6.74). Conclusions: Compared with youths living in urban areas, youths living in rural areas had higher ED visit rates for self-harm, including self-inflicted firearm injuries. Preventive approaches for self-harm based in community and ED settings might help address these differences.
KW - emergency medicine
KW - rural health
KW - self-harm
KW - suicide
UR - http://www.scopus.com/inward/record.url?scp=85111528564&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85111528564&partnerID=8YFLogxK
U2 - 10.1016/j.jpeds.2021.07.013
DO - 10.1016/j.jpeds.2021.07.013
M3 - Article
C2 - 34274309
AN - SCOPUS:85111528564
SN - 0022-3476
VL - 238
SP - 282-289.e1
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -
