Predictors of Suicidal Ideation Among Elementary School-aged Patients Seen in a Pediatric Emergency Department for Behavioral Health Chief Complaints

Background: From 2006 to 2011, behavioral health related hospitalizations increased by nearly 50% and ED visits increased by 21% among 10- to 14-year-old children. While suicide is the second leading cause of death in this age group, information regarding the prevalence, predictors, and treatment for suicide-related behaviors is scarce, especially for children under the age of 12. For children above the age of 12, older age, female sex, childhood maltreatment, and bullying were significant predictors of suicidal ideation (SI). We sought to determine the demographic, social, and behavioral risk factors associated with SI in elementary school-aged children as compared to other behavioral health chief complaints for seeking emergency medical care.

Methods: A retrospective analysis was conducted using data from all 5 to 12-year-old children seen at a large, urban pediatric Emergency Department for a behavioral health chief complaint between June 1, 2017 and May 31, 2018. Patients seen for a chief complaint of suicidal attempt or who had a history of suicide attempt were excluded. Data on patient demographics, medical and behavioral health history were abstracted manually from the electronic medical record. A multivariate logistic regression model was fit for the association between statistically significant bivariate risk factors and SI. All analyses were performed by using SAS version 9.4 (Carey, NC).

Results: The study population included 393 children, of whom 223 (56.7%) were seen for SI and 170 (43.3%) were seen for behavioral health reasons other than SI (Table 1). Patients with SI and other behavioral health patients had similar demographic characteristics and were majority male (68.4%), white (48.1%), non-Hispanic (57.8%), and covered by public health insurance (51.9%). Compared to patients seen for other behavior health reasons patients seen for SI were more likely to: have a diagnosis or other chief complaint of depression (aOR = 2.88; 95% CI = 1.54, 5.40), have a family history of psychiatric disorders (aOR = 2.03; 95% CI = 1.27, 3.25), have experienced bullying (aOR = 2.82; 95% CI = 1.48, 5.39), have been a victim of any abuse (aOR= 2.01; 95% CI= 1.10–3.64), and were of older age (aOR= 1.33; 95% CI= 1.17–1.52).

Conclusion: We found that the majority of elementary school aged children presenting to the emergency department for a behavioral/mental health reason were seen for SI. Similar to studies done among older adolescents, depression, psychiatric family history, bullying, abuse, and increasing age were associated with SI among young children presenting to the ED. To our knowledge, this is the first study examining risk factors associated with SI in children ages 5–12. SI is commonly encountered in elementary school-aged children with behavioral health chief complaints. Additional studies on prevalence of and risk factors for SI in this younger population are warranted.