May 25, 2010

Emergency Department Visits for Drug-related Suicide Attempts by Young Adults Aged 18 to 24: 2008

Suicide is a major public health problem in the United States that impacts thousands of young adults and their families and friends each year. With about 3,500 completed suicides among young adults aged 18 to 24 in 2006, suicide ranks as the third leading cause of death in this age group.¹ The data on completed suicides present only part of this public health problem. Suicide attempts are a recognized risk factor for subsequent completed suicides, and there are between 100 and 200 attempted suicides for every completed suicide among young adults.^2,3 The 2008 National Survey on Drug Use and Health (NSDUH) found that 1.2 percent of young adults aged 18 to 25 had attempted suicide; these rates were 3 times higher than those of adults in other age groups.⁴ Young adults also had the highest rates of suicidal thoughts (6.7 percent) and suicide planning (1.9 percent) of any age group.

The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related emergency department (ED) visits in the United States.^5,6 To be a DAWN case, the ED visit must have involved a drug, either as the direct cause of the visit or as a contributing factor. DAWN data can be used to examine ED visits for drug-related suicide attempts. Although DAWN includes only suicide attempts that involve drugs, these attempts are not limited to drug overdoses. If there is drug involvement in a suicide attempt by other means (e.g., cut wrists while drinking alcohol), the case is included as drug related. Excluded are suicide attempts with no drug involvement and suicide-related behaviors other than actual attempts (e.g., suicidal ideation or suicidal thoughts); also excluded are suicide attempts involving just alcohol for patients aged 21 or older. This issue of The DAWN Report focuses on ED visits resulting from drug-related suicide attempts by young adults aged 18 to 24; other reports focus on visits involving suicide attempts among other age groups.

During 2008, an estimated 604,808 drug-related ED visits were made by young adults aged 18 to 24, of which 6.3 percent (38,036 visits) involved a suicide attempt. Many of the ED visits for drug-related suicide attempts involved multiple drugs, with an overall average of 2.2 drugs (including alcohol) per ED visit (2.4 for males; 2.0 for females). Almost three of every five (57.6 percent) of the ED visits for drug-related suicide attempts were made by females.

Pharmaceuticals were involved in 92.8 percent of ED visits for drug-related suicide attempts among young adults (Table 1). Alcohol, sometimes combined with other drugs, was involved in 3 out of 10 (30.3 percent) visits. Illicit drugs were involved in more than one fifth of these visits (21.9 percent), with marijuana (14.7 percent) and cocaine (6.2 percent) accounting for the largest proportions of these substances.⁷

Anti-anxiety drugs were involved in 26.9 percent of the visits, the majority of which were related to use of benzodiazepines (16.7 percent). Antidepressants were involved in 17.6 percent of visits; 11.7 percent were accounted for by selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine. Antipsychotics, narcotic painkillers, and anticonvulsants each were involved in about 1 out of 10 visits (12.9, 11.4, and 9.3 percent, respectively). Pain medications containing acetaminophen or ibuprofen as their main ingredient were involved in 15.1 percent and 11.3 percent of ED visits for drug-related suicide attempts among young adults, respectively. Other prescription and over-the-counter (OTC) pharmaceuticals involved in suicide attempts among young adults typically were found at levels less than 5 percent, including respiratory agents, gastrointestinal agents (e.g., laxatives), and cardiovascular agents (data not shown).

The drugs involved in ED visits for drug-related suicide attempts varied by gender (Figure 1). For example, in comparison with females, males had significantly higher proportions of visits involving illicit drugs (29.6 vs. 14.8 percent) and antipsychotics (18.1 vs. 9.2 percent). Although not statistically significant, a higher percentage of visits made by males involved alcohol in comparison with visits made by females (38.5 vs. 23.0 percent). Antidepressants were indicated in 19.4 percent of visits by females compared with 15.6 percent of ED visits by males.

Figure 1. Selected Substances Involved in Emergency Department (ED) Visits for Drug-related Suicide Attempts by Young Adults, by Gender: 2008

Follow-up care in DAWN is defined as admission to an inpatient unit in the hospital, transfer to another health care facility, or referral to detoxification. Slightly less than three fourths (72.1 percent) of the ED visits for drug-related suicide attempts among young adults ended with evidence of follow-up care. More than 75 percent of visits involving acetaminophen products, anti-anxiety drugs, ibuprofen products, and antidepressants resulted in evidence of follow-up care compared with about 65 percent of visits involving narcotic painkillers and about 60 percent of visits involving alcohol and illicit drugs (Figure 2).

Figure 2. Disposition of Emergency Department (ED) Visits Involving Drug-related Suicide Attempts by Young Adults, by Selected Type of Drug Involved: 2008

EDs are a key access point to the health care system for people who have attempted suicide and are a strategic location for providing timely intervention.⁸ Although most drug-related ED visits involving suicide attempts among young adults had evidence of follow-up care, a significant minority proportion (nearly 30 percent) did not. Additionally, about 4 in 10 visits associated with alcohol and illicit drugs ended with no evidence of follow-up. These findings may point to the need for increased education and awareness among ED staff about the importance of follow-up care for involvement with these particular substances.

Among young adults, females constituted a larger proportion of ED visits for drug-related suicide attempts than males, and the drugs involved with these attempts differed by gender. Thus, it may be important for health care professionals to consider these gender differences as they triage, assess, and intervene with patients and plan for aftercare. Continuing research is needed to examine how assessments, treatment interventions, and prevention programs can be tailored to account for demographic characteristics (e.g., age, gender, race) and other critical factors (e.g., mental health problems, alcohol and drug use, employment status) associated with this population.

This page was last updated on September 29, 2009.