Archives

Trends in mortality after emergency department presentation for suicidal behaviour in California

Introduction

Emergency department patients presenting with non-fatal suicidal behaviour face elevated risk of suicide and all-cause mortality, but the extent to which this has changed over time is unknown. This study tracked trends in mortality risks faced by emergency department patients presenting with deliberate self-harm and suicidal ideation in California.

Methods

Using statewide linked emergency department and death data, we estimated 2010–2016 trends in suicide and all-cause mortality among emergency department patients with either deliberate self-harm (n=111 658) or suicidal ideation (n=162 959). We also calculated average annual percent changes in age-adjusted mortality rates and compared these to the general California population.

Results

Deliberate self-harm and suicidal ideation patients’ age-adjusted suicide rates decreased by approximately 5% per year during the study period; however, their all-cause mortality trends were flat. In the general California population, suicide rate trends were flat while all-cause mortality slightly declined.

Conclusions

Suicide mortality unexpectedly declined among self-harming and suicidal patients presenting to California emergency departments. Additional research is needed to understand the reasons behind this decline and inform quality improvement efforts for suicide prevention in hospital settings.

Violent deaths among individuals subject to domestic violence protection orders

Objectives

Individuals (ie, respondents) subject to domestic violence protection orders have threatened or engaged in one form of violence perpetration and may be at increased risk for experiencing others forms of violence, including violent death.

Methods

Using a cohort of granted domestic violence protection orders in King County, Washington, USA, from 2014 to 2020 (n=3543), we calculated standardised mortality ratios for violent death, including suicide, homicide, legal intervention and undetermined intent, comparing domestic violence protection order respondents to King County residents adjusting for year, age, sex, and race and ethnicity through indirect standardisation.

Results

There were 66 deaths among domestic violence protection order respondents; 25.8% were violent deaths and 52.9% of violent deaths involved firearms. The standardised mortality ratio for violent death was 3.71 (95% CI: 2.16 to 5.93) among domestic violence protection order respondents compared with King County residents.

Conclusion

The domestic violence protection order process may provide an opportunity for referrals to services to address shared risk factors for violence perpetration and victimisation.

Sequelae and Care After Firearm Injury

This JAMA Insights discusses evidence about the care of patients with firearm injury, including management of chronic pain, peripheral nerve injury, and lead toxicity from bullet fragments.

Epidemiology of community firearm violence in NYC

Endemic levels of community firearm violence in United States cities disproportionately burden certain sociodemographic groups. Nonfatal injuries are an understudied aspect of firearm violence. Police data in …