Abstract
Background:
Suicide is a leading cause of death in the pediatric population and suicide attempts have increased over the years. This study aims to identify risk factors and patterns in this vulnerable population.
Methods:
The Nationwide Readmission Database 2010-2014 was used to identify patients 8-17 years admitted with a diagnosis of suicide attempt. Prior admissions within 1 year were acquired. Multivariable binary logistic regressions to create a hypothesis-generating model of risk factors for age groups.
Results:
We identified 108,248 patients (72% female) with a median age of 15. The most common mechanisms were drug ingestion (69%), cutting (23%), hanging (5%), and firearm (3%). Mental health diagnoses at admission included depression (59%), bipolar disorder (27%), anxiety/panic disorders (26%), and conduct disorder (17%). Substance use was common including cannabis (14%), tobacco (10%), alcohol (7%), with 6% were using multiple drugs. Sexual or physical abuse was found in 10% and the mortality was 1% (825 patients). Prior to the patient's admission for suicide attempt, 12% had a prior admission within a year. Of those that had prior admissions, 27% had multiple previous admissions. During their prior admission, the patients presented with depression (50%), bipolar disorder (34%), anxiety (25%), conduct disorder (24%), and experiencing abuse (13%). Younger children were more likely to experience abuse, attempt suicide by hanging, and have bipolar/conduct disorder whereas older children were more likely to attempt suicide using drugs or firearms. The youngest cohort had a higher mortality rate than their older counterparts.
Conclusions:
Concomitant mental health disorders and substance use are common with pediatric suicide and children often experience multiple hospitalizations prior to an attempt. While less common, younger children have often sustained abuse and have a higher mortality. Practitioners should have a high index of suspicion when managing this high-risk population.