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TOPLINE: 

Emergency department (ED) visits for suicidal thoughts and behaviors (STB) among US children aged 8-12 years increased from 2010 to 2020, with many children returning within months.

METHODOLOGY:

• Researchers examined electronic health records of children aged 8-12 years who presented to the ED between 2010 and 2020 using the State Emergency Department Databases. The analysis included 10,131,432 ED visits across 12 states; of these, 627,517 ED visits were for mental health concerns and/or STB.
• Patients were followed up for up to 1 year after their ED visit to capture subsequent ED visits for STB.
• The visits were categorized as either for STB or for other non-STB mental health causes.

TAKEAWAY:

• STB accounted for 15% of pediatric mental health and/or STB ED visits, increasing from 5% in 2010 to 10% in 2020.
• Children visiting for STB were more often girls (55% vs 35%), older (mean age, 10.87 vs 10.25 years), White, privately insured, and from higher-income, less urban areas compared with those visiting for other mental health causes.
• Most ED visits for suicidal behavior involved ingestion (43%) or injury by a sharp or blunt object (39%); visits involving ingestion cases were longer, more complex, and more costly.
• STB at the index visit strongly predicted return for STB within 1 year (adjusted odds ratio, 9.71; 99% CI, 9.66-9.76), with most returns occurring within 3 months; the risk for STB was higher among girls, those without private insurance, and those with more comorbidities.

IN PRACTICE:

"EHR [electronic health records] have been an underused data source that can help inform large-scale patterns in STB and ED care," the authors wrote. "Future studies combining structured EHR data, narrative clinician notes, and prospective assessment can enhance understanding of suicide risk and recurrence among children in the ED," they added.

SOURCE:

The study was led by David Pagliaccio, PhD, Columbia University, New York City. It was published online on July 22, 2025, in JAMA Network Open.

LIMITATIONS:

Potential underreporting or differences in coding practices leading to possible misclassification, the lack of narrative clinical details and individual socioeconomic data, and follow-up confined to ED visits within the participating state databases may have led to an underestimation of true STB recurrence.

DISCLOSURES: 

The study received support from the National Institute of Mental Health, Morgan Stanley Foundation, and Bender-Fishbein Foundation. One author reported receiving consulting fees and equity from Get Sonar and consulting fees from RPA Health Consulting and Covington and Burling, which represents a social media company in litigation.

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