title: Number of visits to the emergency department and risk of suicide: a population-based case-control study.
abstract: BACKGROUND
  The aim was to study whether number of visits to emergency department (ED) is associated with suicide, taking into consideration known risk factors.
  
  
  METHODS
  This is a population-based case-control study nested in a cohort. Computerized database on attendees to ED (during 2002-2008) was record linked to nation-wide death registry to identify 152 cases, and randomly selected 1520 controls. The study was confined to patients attending the ED, who were subsequently discharged, and not admitted to hospital ward. Odds ratio (OR) and 95% confidence intervals (CI) of suicide risk according to number of visits (logistic regression) adjusted for age, gender, mental and behavioral disorders, non-causative diagnosis, and drug poisonings.
  
  
  RESULTS
  Suicide cases had on average attended the ED four times, while controls attended twice. The OR for attendance due to mental and behavioral disorders was 3.08 (95% CI 1.61-5.88), 1.60 (95% CI 1.06-2.43) for non-causative diagnosis, and 5.08 (95% CI 1.69-15.25) for poisoning. The ORs increased gradually with increasing number of visits. Adjusted for age, gender, and the above mentioned diagnoses, the OR for three attendances was 2.17, for five attendances 2.60, for seven attendances 5.97, and for nine attendances 12.18 compared with those who had one visit.
  
  
  CONCLUSIONS
  Number of visits to the ED is an independent risk factor for suicide adjusted for other known and important risk factors. The prevalence of four or more visits was 40% among cases compared with 10% among controls. This new risk factor may open new venues for suicide prevention.
authors.affiliation: Landspitali the National University Hospital, Reykjavik, Iceland. runarkvaran@gmail.com.
authors.forename: Runar Bragi
authors.initials: RB
authors.lastname: Kvaran
authors.affiliation: Office of Education, Research and Development, Landspitali the National University Hospital, Reykjavik, Iceland. oddnygun@landspitali.is.
authors.forename: Oddny Sigurborg
authors.initials: OS
authors.lastname: Gunnarsdottir
authors.affiliation: The Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland. addab@simnet.is.
authors.forename: Adalbjorg
authors.initials: A
authors.lastname: Kristbjornsdottir
authors.affiliation: The Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland. unnurav@hi.is.
authors.forename: Unnur A
authors.initials: UA
authors.lastname: Valdimarsdottir
authors.affiliation: Department of Preventive Medicine, University of Iceland, Reykjavik, IS-101, Iceland. vilraf@hi.is.
authors.forename: Vilhjalmur
authors.initials: V
authors.lastname: Rafnsson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D064420:Drug-Related Side Effects and Adverse Reactions; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data*; D015995:Prevalence; D012306:Risk; D012307:Risk Factors; D012737:Sex Factors; D013405:Suicide / Q000706:statistics & numerical data*