Emergency Care Follow-Up for Children and Adolescents With Suicide Attempts or Ideation

Death by suicide is the second-leading cause of death for young people in Canada. Because 10% to 15% of the people seen in hospital emergency departments for a suicide attempt will repeat the attempt within 12 months following their discharge, it is important to identify what interventions are effective for preventing further self-harm during this time. Active follow-up care following an emergency department visit for a suicide attempt is common; however, it is unclear what type (e.g., text message, home visit) or timing (e.g., 24 hours, within 72 hours after emergency department discharge) of interventions is most effective for preventing further self-harm in people younger than 18 years. The objective of this review is to summarize the evidence regarding the clinical effectiveness of active contact and follow-up interventions, and the timing and duration of care, for children and adolescents (younger than 18 years) who present to emergency care for suicide attempts or suicide ideations. For children and adolescents presenting to the emergency department for suicide attempts or ideation, telephone-based follow-up care initiated within 1 week of discharge may not affect the number of people who completed the full course of postdischarge treatment, the mean number of sessions attended, or the number of suicide deaths. This finding was based on evidence from 2 systematic reviews, each with 1 primary study relevant to this report. The small sample sizes of these studies (N = 64 and N = 97) and their limited or unclear quality should be considered when interpreting these results. None of the relevant primary studies within the systematic reviews reported on mental health outcomes (e.g., depression, social functioning) or harms from the intervention. No studies were found that evaluated the clinical effectiveness of other methods of active follow-up care or of different time durations of follow-up care for children and adolescents who present to emergency care for suicide attempts or suicide ideations that met our criteria for this review. No evidence-based guidelines were identified that provided recommendations about timing, modality, and which health care professionals should be involved in follow-up care for children and adolescents who present to emergency care for suicide attempts or ideations that met our criteria for this review. Guidance documents and guidelines for adults generally recommend that follow-up should occur within 48 hours, particularly for those with safety concerns of subsequent self-harm. These guidance documents also suggest different modalities for follow-up during that time, including telephone calls, visits, and electronic communication. Given the higher risk and potential vulnerability experienced by children and adolescents and the absence of formal clinical guidelines, person-centred follow-up care for all children and adolescents within 48 hours may be considered, similar to adults who present with high concerns.

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