Citation

Hoffmann JA, Hall M, Lorenz D, Berry J. J. Pediatr. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Elsevier Publishing)

DOI

10.1016/j.jpeds.2021.07.013

PMID

unavailable

Abstract

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: Retrospective analysis of ED visits for suicidal ideation and/or self-harm by youth age 5-to-19 years (N=297,640) in the 2016 Nationwide Emergency Department Sample, a representative sample of all U.S. 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 U.S. Census region. For self-harm visits, we compared injury mechanisms by urban-rural location.

RESULTS: Among 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 (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 were higher among youth living in rural than in urban areas for self-inflicted firearm injuries (aIRR = 3.03, 95% CI 1.32, 6.74).

CONCLUSIONS: Compared with youth living in urban areas, youth 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.

Language: en

Keywords

Emergency Medicine; Suicide; Rural Health; Self-Harm