Chronic Suicidality in Youth Admitted for Mental Health Emergencies: A Retrospective Chart Review.

Introduction: Suicide is a leading cause of death among youth in the United States. Most youth who attempt suicide have underlying mental health disorders, which account for approximately 10% of pediatric hospitalizations. Researchers hypothesized that children with chronic suicidality (CS) have more suicide-related risk factors, attempt suicide with greater lethality, and have more pre-existing mental health diagnoses compared to those without chronic suicidality (Non-CS). Methods: The study team reviewed pediatric hospitalizations related to suicide at Wesley Medical Center from 2016 to 2021. CS was defined as a reported history of, or prior hospitalization for, suicide-related behavior. The severity of suicidal ideation/behavior and actual lethality or medical damage was measured using the Columbia-Suicide Severity Rating Scale (C-SSRS). Results: Of 375 patients, 253 were classified as CS and 122 as Non-CS. Age and race distributions were similar between groups. Females were more likely to have CS (p = 0.0006). Patients with CS were more often admitted for suicide attempts rather than non-suicidal self-injury (p = 0.0171). No significant differences were found in method or lethality of attempts.Patients with CS experienced more peer stress, abuse, legal problems, and job-related issues (all p <0.05). No differences were observed in other stressors. CS patients had more prior mental health treatment (p <0.0001) and were more frequently discharged to inpatient mental health care (p <0.0001). Conclusions: Female gender and psychosocial stressors were associated with increased risk of chronic suicidality in youth. Early identification of these factors may enable earlier interventions to prevent suicide-related behaviors.