Suicide Risk in 8- to 12-Year-Old Children: Retrospective Review of Emergency Department Electronic Health Records.

Objective: As of 2021, suicide has increased to the third leading cause of death among children 8 to 12 years of age. Children presenting to the emergency department (ED) for suicide thoughts and behaviors (STB) are at high risk for recurrent behavioral health (BH) concerns. This study leveraged electronic health records (EHR) to identify risk factors for STB and return ED visits. Method: EHR for 920 patients 8 to 12 years of age (N = 1,310 visits) who indicated STB or BH concerns or had a psychiatric consultation in the pediatric ED of a metropolitan hospital were reviewed from 2020 to 2023. Structured data (eg, demographics, diagnoses) were combined with clinician free-text notes. Results: STB were frequently indicated among BH patients (65%). Ingestion was the most common injury cause from acute suicide behavior (71%). Most suicide behavior was linked to family/social triggers (56%); 21% included conflict over social media/technology. Psychosocial factors differentiated STB from other BH cases, including bullying, impulsivity, irritability, sleep, and LGBTQ+ identity (odds ratio = 2.09-6.46). Of the patients, 13% had multiple visits implicating STB. Most subsequent ED returns were within 3 months of discharge (median = 89 days). Prior psychiatric hospitalization was the strongest predictor of ED returns for subsequent STB within 1 year (odds ratio = 3.27). Conclusion: Suicide risk is common among 8- to 12-year-old children seeking psychiatric emergency services. EHR provide critical data for understanding this public health challenge and can guide enhancement of pediatric screenings for suicide risk, including detailed assessment of symptoms (eg, impulsivity, sleep disruption) and psychosocial context (eg, bullying, LGBTQ+ identity). Helping families increase safety around ingestible lethal means remains a key point of intervention. Diversity & Inclusion Statement: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.