According to the CDC, suicide is the seventh-leading cause of death among males. A 2007 analysis demonstrated that men committed suicide nearly four times more often than women. In 2010, the Substance Abuse and Mental Health Services Administration (SAMHSA) reported that people with substance abuse problems reported serious thoughts of suicide three times more often than those who were not dependent on these substances. The CDC has also reported that a previous suicide attempt is one of the strongest predictors for a completed suicide, making the examination of drug-related ED visits involving a suicide attempt an important public health issue. Learning about patterns in suicidal behaviors among men at the highest risk for suicide is important to reducing the burden of this growing problem. Access to information on trends could help to improve prevention and treatment efforts.

Current Trends in Suicide Attempts

A recent SAMHSA investigation based on ongoing data collection from hospital EDs reviewed medical records to identify trends in ED visits for drug-related suicide attempts among men in 2005 and 2009. The study—conducted as part of the Drug Abuse Warning Network and directed by Albert Woodward, PhD, MBA, and colleagues—found that the number of ED visits for drug-related suicide attempts increased among all age groups during the study period, but a statistically significant jump of 55% was observed among men aged 21 to 34 (Figure). Men in this age group accounted for nearly 30,000 of the 77,971 total ED visits for drug-related suicide attempts in 2009. These findings parallel data that rank suicide as the third-leading cause of death, and substance misuse prevalence was highest among this age group in men.

“Learning about patterns in suicidal behaviors among men at the highest risk
for suicide is important to reducing the burden of this growing problem.”

ED visits for drug-related suicide attempts among all men increased across the board for all selected drugs, including alcohol, that were reviewed in the study (Table), with the exception of cocaine (-13%) and stimulants (-63%). Among those aged 21 to 34, such visits involving antidepressants increased by 155%, and those involving anxiety and insomnia medications increased by 93%. “Among males aged 35 to 49, ED visits for drug-related suicide attempts involving narcotic pain relievers almost doubled,” adds Dr. Woodward. “That number almost tripled in men aged 50 and older.”

Dr. Woodward notes that an important point for ED care providers to recognize is that there are different combinations of substances involved in these attempts. “In most ED visits—suicide-related or not—people coming into the ED often have more than one drug involved. With suicide attempts, we see different patterns of prescription drugs that vary by several factors, most notably age. The patterns of which types of drugs are being used confirm that these patterns are a problem and that efforts are needed to address these individuals.”

The SAMHSA report did not compare drug-related suicide attempts among men and women, but Dr. Woodward noted that a separate report has shown that the numbers in 2009 were 215,000 for females and 77,971 for males. “Although women are treated for drug-related attempted suicide more often than men,” he says, “men have higher suicide death rates. This may have implications on how targeted interventions are developed.”

Preventing Repeat Suicide Attempts

According to Dr. Woodward and colleagues, specialized screening and assessment for other mental illnesses should be an integral part of preventing repeat drug-related suicide attempts among men. “When examining the problem of male suicide attempts, age is an important factor that should not be overlooked,” Dr. Woodward says. “Specialized screenings and assessments should account for age when targeting efforts for preventing repeat attempts. It’s also important to make sure that referrals are made so that male patients are assessed by psychologists and/or psychiatrists during their ED visit and then immediately afterward. These efforts must be sustained for the long term in order to be successful.”

The United States Preventive Services Task Force has published Screening for Suicide Risk: Recommendation and Rationale, a resource of additional information for ED clinicians managing patients who have attempted suicide. The publication, which provides a brief summary as well as a complete evidence-based review, is available for free online at www.uspreventiveservicestaskforce.org/uspstf/uspssuic.htm. Dr. Woodward recommends that EDs review this resource to help prevent future suicide attempts. He also suggests that ED nurses and physicians inform patients who have attempted suicide about the National Suicide Prevention Lifeline, available via phone at 800-273-TALK or online at www.suicideprevention lifeline.org. “EDs are on the front line for treating drug-related suicide attempts, and becoming aware of helpful resources will hopefully lead to fewer repeat attempts.”

References

Substance Abuse and Mental Health Services Administration. The DAWN Report: Trends in emergency department visits for drug-related suicide attempts among males: 2005 and 2009. Available at http://oas.samhsa.gov/2k11/DAWN018/DAWN018.cfm.

U.S. Preventive Services Task Force. (2004, May). Screening for suicide risk: Recommendation and rationale. Available at www.uspreventiveservicestaskforce.org/3rduspstf/suicide/suiciderr.htm. Accessed July 18, 2011.

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2011, February 24). Injury prevention & control: Data & statistics (WISQARS). Available at www.cdc.gov/injury/wisqars/index.html. Accessed July 18, 2011.

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2009). Suicide facts at a glance. Available at www.cdc.gov/violenceprevention/pdf/Suicide-DataSheet-a.pdf. Accessed July 18, 2011.