Demographic predictors of emergency service utilization patterns in youth at risk of suicide

Objective: To explore demographic predictors of Emergency Department (ED) utilization among youth with a history of suicidality (i.e., ideation or behaviors). Methods: Electronic health records were extracted from 2017 to 2021 for 3094 8–22 year-old patients with a history of suicidality at an urban academic medical center ED in the Mid-Atlantic. Logistic regression analyses were used to assess for demographic predictors of ED utilization frequency, timing of subsequent visits, and reasons for subsequent visits over a 24-month follow-up period. Results: Black race (OR = 1.45, 95% CI = 1.11–1.92), Female sex (OR = 1.59, 95% CI = 1.26–2.03), and having Medicaid insurance (OR = 1.71, 95% CI = 1.37–2.14) were associated with increased utilization, while being under 18 was associated with lower utilization (<12: OR = 0.38, 95% CI = 0.26–0.56; 12–18: OR = 0.47, 95% CI = 0.35–0.63). These demographics were also associated with ED readmission within 90 days, while being under 18 was associated with a lower odds of readmission. Conclusions: Among patients with a history of suicidality, those who identify as Black, young adults, patients with Medicaid, and female patients were more likely to be frequent utilizers of the ED within the 2 years following their initial visit. This pattern may suggest inadequate health care access for these groups, and a need to develop better care coordination with an intersectional focus to facilitate utilization of other health services.