TOPLINE

Among adolescents who screened positive for suicide risk in the emergency department (ED), more than 1 in 10 attempted suicide within 3 months. A recent suicide attempt, prior mental health hospitalization, history of nonsuicidal self-injury, and hopelessness were linked to an increased risk for subsequent suicide attempts, whereas stronger social connectedness appeared protective.

METHODOLOGY

• Researchers conducted a secondary analysis including 2085 adolescents aged 12-17 years (40.7% aged 14-15 years; 65.5% females; 49.0% non-Hispanic White adolescents) with a positive Ask Suicide-Screening Questions (ASQ) screen from the Pediatric Emergency Care Applied Research Network's ED-STARS studies 1 and 2, which were conducted from June 2015 to February 2019.
• Participants were assessed using comprehensive suicide risk measures, sociodemographic variables, and self-reported risk factor surveys during the index ED visit, along with follow-up interviews and medical chart reviews.
• Primary outcomes were subsequent suicide attempts and mental health-related ED revisit or hospitalization within 3 months of the index ED visit; factors associated with these outcomes were identified. 

TAKEAWAY

• Within 3 months of the index ED visit, 11.6% of adolescents attempted suicide and 19.9% had a mental health-related ED revisit or hospitalization.
• Factors associated with subsequent suicide attempts within 3 months of the index ED visit included a suicide attempt in the month preceding the visit (adjusted odds ratio [aOR], 2.52; 95% CI, 1.84-3.45), prior mental health hospitalization (aOR, 1.39; 95% CI, 1.02-1.90), past nonsuicidal self-injury (aOR, 2.06; 95% CI, 1.41-3.01), and hopelessness during the index visit (aOR, 1.30; 95% CI, 1.04-1.63).
• Males had lower adjusted odds of subsequent suicide attempts than females (aOR, 0.62; 95% CI, 0.42-0.90), and stronger social connectedness was associated with a reduced risk for subsequent suicide attempts (aOR, 0.91; 95% CI, 0.85-0.97).
• Factors associated with mental health-related ED revisit or hospitalization within 3 months of the index ED visit included prior mental health hospitalization (aOR, 2.23; 95% CI, 1.74-2.84), a suicide attempt in the month preceding the index ED visit (aOR, 1.63; 95% CI, 1.24-2.14), and hopelessness during the index visit (aOR, 1.44; 95% CI, 1.21-1.72).

IN PRACTICE

"Our findings suggest that hopelessness and social connectedness are important modifiable factors," the authors wrote. "Communicating these risk factors to families and outpatient or school-based mental health providers, along with ED-initiated interventions to reduce hopelessness and strengthen social connectedness, could meaningfully improve care for youth who screen positive for suicide risk," they added.

SOURCE

The study was led by Ashley A. Foster, MD, University of California, San Francisco. It was published online on September 25, 2026, in the Annals of Emergency Medicine.

LIMITATIONS

The study included only English-speaking participants and was conducted at academic centers with pediatric EDs, mainly in urban areas, which may have limited the generalizability of the findings. The sample was enriched for suicide risk, and the findings may not apply to the general ED population.

DISCLOSURES

The study was funded by the Hellman Foundation. One author reported receiving funding outside of the submitted work from the Pediatric Pandemic Network and Abbott Laboratories. Another author reported receiving support from the National Institute of Mental Health. Additional disclosures are given in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.