Suicide decedent presentations to the Emergency Department: a 10-year data linkage analysis evaluating non-mental health-related presentations in the year preceding suicide in Victoria, Australia.

Introduction: People who die by suicide are known to attend Emergency Departments (EDs) prior to death. Eliciting and screening for mental distress among people with non-psychiatric, medical or injury-related complaints remains challenging for clinicians worldwide. There remains a lack of data evaluating emergency presentations preceding suicide, which may lead to missed or underutilised opportunities for intervention or assessment. Methods: This population-based retrospective data linkage study analysed ED attendances of all 6423 suicide decedents in Victoria, Australia over 18 years old who died between 2011 and 2020 according to the Victorian Suicide Register and the Victorian Emergency Minimum Dataset. We specifically examined presentations not obviously pertaining to mental health, alcohol/substance use or addiction issues (non-MHAOD). Results: 2779 decedents (43.3% of all Victorian suicide decedents) had 8218 attendances (excluding death on arrival/in ED) within the year preceding death. 1127 decedents had exclusively non-MHAOD presentations (40.6%); 863 decedents (31.1%) had only MHAOD presentations. 789 decedents (28.4%) had both MHAOD and non-MHAOD presentations. Compared with decedents with any mental health presentations, non-MHAOD decedents were more likely to be older, male and live in regional areas with moderate or limited access to services (including tertiary healthcare). The most prevalent non-MHAOD diagnosis category was injury and in particular upper limb injuries; 70.9% of these presentations cited 'non-intentional harm' as injury intent. Conclusions: EDs remain a point of healthcare contact prior to suicide, particularly for older, male, regional decedents who historically may not access healthcare elsewhere but have been identified here as ED patients. Findings reinforce existing evidence associating suicide and physical comorbidity. Male decedents presented with injuries which may have occurred due to interpersonal violence (potentially related to mental distress) or which may have subsequently precipitated suicidality given the high incidence of non-intentional harm. As such, there is an impetus for improved surveillance, opportunistic engagement and screening.