1. Trends in Emergency Department Visits by Young Adults for Suicide Attempts in Connecticut, 2011-2015
Elizabeth McOsker
October 30, 2017
University of Florida MPH Thesis
Internship at UConn Center for Public Health and Health Policy
I completed my MPH internship at the Uconn Center for Public Health and Health Policy where I researched trends in ED Visits by Young Adults for Suicide Attempts in CT from

2. Study Objectives
Develop an understanding of the demographic and social trends among young adult suicide attempts that do not result in hospitalizations in CT
Quantitatively assess suicide risk among Connecticut young adults in order to focus prevention efforts
Contribute to a broad understanding of demographic, social, and economic factors relating to suicide attempts among young adults in CT
The objectives of this study were to examine the demographic and social trends of young adult ED-non admissions for suicide attempts, to assess risk, and to contribute to the broad understanding of factors relating to suicide attempts in CT.//

3. Methodology ChimeData
De-identified patient level data
Administrative discharge (UB-04 claims-based) data from inpatient admissions, hospital-based outpatient surgery, and ED non-admissions from all 30 of Connecticut’s acute care facilities
Project approved by both the University of Florida and the University of Connecticut Health Center Institutional Review Board
I used de-identified patient level data from Chime Data, which is the administrative discharge data from all 30 of CT’s acute care facilities. Approximately 2/3 of suicide attempts seen in the ED are discharged home, so this is an important data set for looking at suicide attempts

4. Methodology SQL Query: Years, patient status, Age
Suspected suicide attempts determined by using BK Ahmedani (2016)’s ICD-9 code query:
Code Type
ICD-9 Codes
Suicide Attempt
E950-E958 (intentional self-harm)
Possible Suicide Attempt
E980-E988 (undetermined intent)
Suicide V-Code
V (suicide ideation) --AND SAME VISIT ,
Suicide Algorithm
881, , , AND SAME VISIT , , , , 298.0, 300.4, , 311, , , , , , 301, , 295, 297, , 299, , 780.1,
To determine suicide attempts via ICD-9 coding, I used a method that was developed by BK Ahmedani that uses supplemental e-codes for injury as well as the suicidal ideation v-code in conjunction with specific injury or poisoning codes, and an algorithm developed to determine potential suicide attempts that were not coded as such.

5. Methodology
Relationships between response variable (suicide attempt) and several exposures: sex, ethnicity/race, age, method of attempt
Rates calculated using National Center for Health Statistics state population estimates
I used SAS version 9.4 to cross-tabulate and count the data and data from the National Center for Health statistics for the population denominators to determine state-level rates

6. Results ED Non-Admit Visits for Suicide Attempts, 15-24 year olds All
2011
2012
2013
2014
2015
Total (N)
9746
1612
2179
2299
2124
1532
Male
43.3%
46.8%
43.5%
42.8%
41.1%
Female
56.7%
53.2%
56.5%
57.2%
58.9%
15-19
53.1%
49.5%
54.1%
53.9%
53.6%
53.5%
20-24
46.9%
50.5%
45.9%
46.1%
46.4%
46.5%
White
64.2%
54.2%
62.3%
67.4%
68.7%
66.4%
Black
11.9%
13.1%
12.8%
10.7%
11.3%
Hispanic
18.9%
18.8%
19.9%
19.0%
17.8%
18.7%
Here is a brief overview of the demographic breakdown of my data. In total, out of 9million encounters examined, 9746 were deemed to be probable suicide attempts. More females than males, more year olds than year olds, and more whites than Black or Hispanic young adults attempted suicide.//

7. Suicide Attempt Rates by Year
2011
2012
2013
2014
2015
Suicide Attempts (per 10,000) of year olds in CT
32.1
43.4
44.7
41.2
29.7
Total Number (N)
1612
2179
2299
2124
1532
The rates of suspected suicide attempts among year olds in Connecticut from saw a rise and fall, suggesting that suicide attempts reached a peak in 2013 and have declined since, although data from future years will be needed to determine if the trend of decreasing attempts continues or if the decreases are an anomaly. //

8. Suicide Attempt Rates by Age Group
2011
2012
2013
2014
2015
Suicide Attempts (per 10,000) of year olds in CT
31.6
46.1
48.8
45.1
32.7
Suicide Attempts (per 10,000) of year olds in CT
35.8
43.7
44.8
40.4
28.9
For every year except 2011, year-olds had higher rates of suicide attempts not resulting in hospital admission than year-olds, which could be because younger adults are more impulsive and less likely to use lethal means that result in death or hospitalization

9. Suicide Attempt Rates by Gender
2011
2012
2013
2014
2015
Suicide Attempts (per 10,000) of year old Males in CT
30.5
38.0
38.9
35.6
24.7
Suicide Attempts (per 10,000) of year old Females in CT
36.8
52.4
55.4
50.5
37.3
For each year studied, females had higher rates than males, which is consistent with the literature

10. Suicide Attempt Rates by Race/Ethnicity
2011
2012
2013
2014
2015
Suicide Attempts (per 10,000) of White year olds in CT
28.2
43.9
50.0
46.9
32.8
Suicide Attempts (per 10,000) of Black year olds in CT
34.2
44.6
38.8
37.7
28.5
Suicide Attempts (per 10,000) of Hispanic year olds in CT
34.4
47.3
46.4
39.3
29.5
Black and Hispanic young adults had higher rates than whites in 2011 and 2012, but in the most recent three years ( ), whites had higher rates of attempts than black or Hispanic young adults. This is also consistent with the literature

11. Methods Used in Suicide Attempt
Poisoning
Hanging
Drowning
Firearm
Cutting
Jumping
Total
59.84%
1.83%
0.07%
1.14%
35.86%
1.25%
15-19 year olds
54.55%
1.54%
0.05%
0.70%
42.01%
1.15%
20-24 year olds
66.56%
2.18%
0.09%
1.71%
28.07%
2.24%
Males
63.83%
2.79%
0.14%
28.20%
Females
57.35%
1.22%
0.02%
0.11%
40.66%
0.63%
Poisoning was the most frequently used method of suicide attempt among ED non-admits, followed by cutting. Hanging, jumping, firearm, and drowning were much less common, in part because such methods are more lethal and are more likely to result in death or severe injury requiring hospitalization

12. Methods Used in Suicide Attempt by Age Group
My data are consistent with literature showing that younger adolescents are more likely attempt by cutting, and that less lethal methods of suicide attempt often escalate to more lethal means as the young adult gets older. //

13. Methods Used in Suicide Attempt by Gender
My research is also consistent with studies that females are most likely to attempt suicide by poisoning or other less lethal methods than males use//

14. Non-Admit versus Inpatient Rates for Suicide Attempts
Rates of ED non-admissions are generally three- to four- times as high as inpatient admissions, so most young adult suicide attempts in CT are not highly medically serious. This means that young adults who are suicidal in Connecticut are an ideal target for interventions and efforts at continued means reduction.

15. Rates by Gender and Age Group
Rates of attempts by females years old were almost double that of males for each year of data. The rates evened out for year olds, so year old young women are at a high risk for suicide attempts. This means that limited suicide prevention funding can be targeted toward this high risk group of young women.

16. Strengths of Study Strengths:
Large, complete data set with individual-level records
Inclusive method for determining possible suicide attempts
Context within existing suicide-related data in CT
Strengths of this study include a large dataset, use of an inclusive method for determining possible suicide attempts, and the ability to contextualize the results with other state data sources

17. Limitations & Generalizability
No data on suicide attempts treated on outpatient basis
Coding practices vary by practitioner, patient, situation
Some data discrepancies (possibly missing)
Rates not generalizable but methods are
Limitations include lack of data on outpatient encounters for attempts, variations in coding, and some missing data
This data cannot be generalized to a population outside of but the methods are generalizable.

18. Implications for Future Research
Baseline data for Zero Suicide Initiative
Grant and program evaluation
Incorporate ED-Non Admit data into ongoing suicide surveillance
Studies comparing methodologies for determining suicide attempts from billing codes
This data can be used for studying trends among facilities going forward, especially in relation to statewide efforts through the Zero Suicide Initiative and Garrett Lee smith Grant.

19. Key Takeaways
Rates of suicide attempts peaked in 2013 and follow similar patterns across demographic variables
Females aged have the highest rates of suicide attempts; however females tend to use less lethal means than males for attempts
Females aged have the highest rates of suicide attempts, but females generally use less lethal means (cutting and poisoning) for attempts than males.

20. Acknowledgements & Contact
Rob Aseltine, PhD, advisor at UConn Health
Krishna Vaddiparti, PhD, MPE, MSW, advisor at University of Florida
Andrea Duarte, MPH, MSW
Contact me:
Thank you to my advisors and mentors, and feel free to contact me with any questions or comments! Thank you!