Population-Based Rates of Youth Suicide-Related Emergency Department Encounters by Rural-Urban Status.

PURPOSE: To compare population-based rates and mechanisms of suicide-related emergency department (ED) encounters among rural and urban youth in Kentucky and Arkansas.

METHODS

We conducted a population-based cross-sectional study using 2018-2021 Healthcare Cost and Utilization Project State Emergency Department Databases linked with U.S. Census population estimates. Suicide-related ED encounters among youth aged 10-19 years were identified using diagnosis codes for suicidal ideation, suicide attempt, and intentional self-harm. Counties were classified using the National Center for Health Statistics urban-rural classification scheme. We calculated rates per 10,000 youth and rural-to-urban incidence rate ratios (IRRs) with 95% confidence intervals (CIs).

FINDINGS: Among 27,098 suicide-related ED encounters, 11,243 (41.5%) occurred among rural youth. Rural youth had a 14% higher population-based encounter rate than urban youth (IRR = 1.14; 95% CI, 1.12-1.17). Rural-urban differences were greatest among youth aged 10-14 years (IRR = 1.26; 95% CI, 1.21-1.31), White youth (IRR = 1.21; 95% CI, 1.18-1.24), and females (IRR = 1.17; 95% CI, 1.13-1.20). Rates were lower among rural than urban Black youth (IRR = 0.86; 95% CI, 0.80-0.92). Mechanisms were similar across settings; suicidal ideation without self-harm accounted for approximately 72% of encounters in both groups.

CONCLUSIONS

Rural youth experienced higher rates of suicide-related ED encounters, particularly younger adolescents and females. Strengthening early identification and access to crisis and outpatient mental health services may help prevent rural youth from progressing to psychiatric emergencies.