Emergency Department Visits for Suicidal Ideation and Self-Harm in Rural and Urban Youths

J Pediatr. 2021 Nov:238:282-289.e1. doi: 10.1016/j.jpeds.2021.07.013. Epub 2021 Jul 15.


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.

Keywords: emergency medicine; rural health; self-harm; suicide.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Male
  • Retrospective Studies
  • Rural Population / statistics & numerical data*
  • Self-Injurious Behavior / epidemiology*
  • Suicidal Ideation*
  • United States
  • Urban Population / statistics & numerical data*
  • Young Adult