Uncovering gender, racial, ethnic, and socioeconomic disparities among adolescent survivors of suicide attempts in trauma centers: Where can we do better?

BACKGROUND

Suicide is the second leading cause of death among adolescents aged 10 years to 17 years. The aim of this study was to examine a nationwide database to identify prevalence, injury patterns, outcomes, and disparities in the receipt of mental health care (MHC) in adolescents presenting following an attempted suicide at US trauma centers (TCs).

METHODS

This is a 5-year (2017-2021) retrospective cohort analysis of the pediatric ACS-TQIP database. All adolescents (aged 10-17 years) presenting following a suicide attempt were included. Patients with superficial minor lacerations were excluded from the study. Outcomes measured were mortality rate among all adolescent patients who presented following a suicide attempt and rates of receiving MHC among survivors. Backward stepwise regression analyses were performed to identify predictors of outcomes.

RESULTS

A total of 3,738 adolescent patients presented to TCs after an attempt at suicide. The prevalence of suicide attempts increased (13.8 cases/1000 TC discharges in 2017 to 14.2 cases/1000 TC discharges in 2021; p < 0.001). Overall, 27% died during the index admission. Among survivors, the median age was 15 years, 64.8% patients were White, 15.6% Black, 16.0% Hispanic, 5.6% uninsured, and 37% were treated at a verified pediatric TC. Overall, 42.7% had a preinjury mental disorder. The most common mechanism of injury was cut/stab (28.3%), followed by firearms (24.3%), blunt mechanisms (20.9%), and asphyxiation (6.4%). Only 36% of survivors received MHC during index admission or on discharge. Firearm injuries, male gender, uninsured status, and Hispanic ethnicity were independent predictors of mortality. Moreover, male gender, Black race, Hispanic ethnicity, uninsured patients, and nonpediatric-verified TCs were associated with lower adjusted odds of receiving MHC.

CONCLUSION

The reported rate of violent suicide attempts in TC increased significantly over the years across the United States. There is a need for improved access to MHC for suicide attempt survivors. Our findings can serve to inform trauma registry data and policymakers by defining suicide attempt patterns and outcomes.

LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.