Population‐Based Rates of Youth Suicide‐Related Emergency Department Encounters by Rural‐Urban Status
Laura M. Prichett, Yurika Tarui, Susan De LucaABSTRACT
Purpose
To compare population‐based rates and mechanisms of suicide‐related emergency department (ED) encounters among rural and urban youth in Kentucky and Arkansas.
Methods
We conducted a population‐based cross‐sectional study using 2018–2021 Healthcare Cost and Utilization Project State Emergency Department Databases linked with U.S. Census population estimates. Suicide‐related ED encounters among youth aged 10–19 years were identified using diagnosis codes for suicidal ideation, suicide attempt, and intentional self‐harm. Counties were classified using the National Center for Health Statistics urban‐rural classification scheme. We calculated rates per 10,000 youth and rural‐to‐urban incidence rate ratios (IRRs) with 95% confidence intervals (CIs).
Findings
Among 27,098 suicide‐related ED encounters, 11,243 (41.5%) occurred among rural youth. Rural youth had a 14% higher population‐based encounter rate than urban youth (IRR = 1.14; 95% CI, 1.12–1.17). Rural–urban differences were greatest among youth aged 10–14 years (IRR = 1.26; 95% CI, 1.21–1.31), White youth (IRR = 1.21; 95% CI, 1.18–1.24), and females (IRR = 1.17; 95% CI, 1.13–1.20). Rates were lower among rural than urban Black youth (IRR = 0.86; 95% CI, 0.80–0.92). Mechanisms were similar across settings; suicidal ideation without self‐harm accounted for approximately 72% of encounters in both groups.
Conclusions
Rural youth experienced higher rates of suicide‐related ED encounters, particularly younger adolescents and females. Strengthening early identification and access to crisis and outpatient mental health services may help prevent rural youth from progressing to psychiatric emergencies.