title: Emergency department utilization among American Indian adolescents who made a suicide attempt: a screening opportunity.
abstract: OBJECTIVE
  Reservation-based American Indian adolescents are at significant risk for suicide. Preventive approaches have not focused on medical service utilization patterns on reservations, which are typically limited to one local emergency department (ED). Patterns of ED utilization before suicide attempts were evaluated to identify opportunities for screening and intervention.
  
  
  METHODS
  Cross-sectional study of Apache adolescents (aged 13-19 years) who attempted suicide and consented to medical chart review. Lifetime presenting problems for Indian Health Service ED visits before the index suicide attempt were extracted and coded.
  
  
  RESULTS
  A total of 1,424 ED visits from 72 Apache adolescents were extracted (median lifetime visits, n = 18). In the year before the attempt, 82% (n = 59) of participants had had an ED visit for any reason and 26% (n = 19) for a psychiatric reason, including suicidal thoughts or self-harm.
  
  
  CONCLUSIONS
  Service utilization data suggest that EDs are critical locations for reservation-based suicide prevention. Suicide screening for all ED patients could increase early identification and treatment of this at-risk group.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Ballard
authors.affiliation: Center for American Indian Health, Johns Hopkins School of Public Health, Baltimore, Maryland.
authors.forename: Lauren
authors.initials: L
authors.lastname: Tingey
authors.affiliation: Center for American Indian Health, Johns Hopkins School of Public Health, Baltimore, Maryland.
authors.forename: Angelita
authors.initials: A
authors.lastname: Lee
authors.affiliation: Center for American Indian Health, Johns Hopkins School of Public Health, Baltimore, Maryland.
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Suttle
authors.affiliation: Center for American Indian Health, Johns Hopkins School of Public Health, Baltimore, Maryland.
authors.forename: Allison
authors.initials: A
authors.lastname: Barlow
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland; Center for American Indian Health, Johns Hopkins School of Public Health, Baltimore, Maryland. Electronic address: mcwik@jhsph.edu.
authors.forename: Mary
authors.initials: M
authors.lastname: Cwik
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006293:Health Promotion; D006801:Humans; D007198:Indians, North American; D008297:Male; D013406:Suicide, Attempted; D014481:United States; D055815:Young Adult; D000092864:Suicide Prevention
keywords: American Indian; Emergency department; Screening; Suicide