Cross-Sectional Examination of Hospital Visits in the Year Prior to Suicide Death in Illinois.

introductionSuicide is a growing public health issue in the United States. Healthcare visits in the year prior to suicide death, including those to emergency departments (ED) and inpatient settings, may be missed opportunities for risk-screening and intervention delivery. Our objective in this study was to evaluate the distribution of hospital visits of suicide decedents in the year prior to death by setting (ED and inpatient), last visit proximity to death, and presence of suicide risk factors, and to consider each setting's potential for reaching those at risk of suicide.

methodsUsing linked data from the Illinois Hospital Discharge Data Set and the Illinois Violent Death Reporting System, we examined suicide decedent hospital visits 365 days prior to suicide death. We described the distribution of visits by setting (ED vs inpatient), timing of the last visit prior to death, and groupings of visit primary diagnosis codes, as per the International Classification of Diseases, 10

resultsOf the 2,562 suicide decedents, 960 (37.4%) had a visit in the year preceding their death. The 960 decedents had a total of 3,131 visits, an average of 3.3. per person. Of those visits, 2,002 (63.9%) were to the ED. However, there was a greater proportion of last visits to an inpatient unit (687, 60.9%) that occurred under 180 days of death compared to last ED visits (1,060, 52.1%), P < .05). Inpatient visits also had higher percentages of visits for each of the suicide risk-diagnosis code groups compared to ED visits; deliberate self-harm, 22.2% (n = 251) vs 6.8% (n = 136); suicidal ideation 29% (n = 327) vs 8.6% (n = 173); mental health disorders, 5.7% (n = 64) vs 3.1% (n = 62); and substance use disorder, 75.1% (n = 848) vs 35.3% (n = 706), P < .05. Among both inpatient and ED visits, substance use was the most prevalent of the primary diagnosis suicide risk-factor groups endorsed, although inpatient visits had a statistically significant higher proportion of primary diagnosis codes for substance use than ED visits, 75.1% (n = 848) and 35.3% (n = 706), respectively, all P < .05.

conclusionWe found the proportion of suicide decedents with a hospital visit in the year prior to death was lower than other studies found for primary care settings. However, this does not mean that broad-based suicide screening and interventions would not be of value in hospital settings.7,14 Inpatient visits were fewer in number but a greater proportion of visits in closer proximity to suicide death and with suicide risk factors. This suggests that EDs may be better suited to broad-based screening and inpatient settings to targeted intervention efforts. Inpatient visits involving primary diagnosis suicide-risk factors may offer more easily identifiable opportunities for suicide prevention compared to those in ED settings, based on prevalence and temporal and logistical factors. Future interventions could consider how to systemically integrate risk screenings in both settings, particularly for patients with a diagnosis of substance use disorder.