title: Substance Use as a Mediator of the Association Between Demographics, Suicide Attempt History, and Future Suicide Attempts in Emergency Department Patients.
abstract: BACKGROUND
  Identification of factors that predict and protect against attempted suicide are critical for the development of effective suicide prevention and intervention programs.
  
  
  OBJECTIVE
  To examine whether substance use mediates the association between demographic characteristics, suicide attempt history, and reports of a suicide attempt within 12 months after screening positive for active suicidal ideation or behavior during the index emergency department (ED) visit.
  
  
  METHODS
  Data were collected during the first two phases of the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study. Data collection included baseline interview; 6- and 12-month chart reviews; and 6-, 12-, 24-, 36-, and 52-week telephone follow-up assessments. Structural equation modeling was used. All p values were two-tailed, with p < .05 considered statistically significant.
  
  
  RESULTS
  Among the 874 subjects, 195 (22%) reported a suicide attempt within 12 months after the index ED visit. Of participants reporting a suicide attempt, 59% were < 40 years old, 59% female, and 76% non-Hispanic White. Associations between race, sex, and suicide attempt 12 months after the index ED visit may be mediated by a combination of alcohol misuse and cocaine use.
  
  
  CONCLUSIONS
  Findings from the mediation analyses provide insight into the impact of substance use on future suicide attempts in various sociodemographic groups.
authors.affiliation: 1 Department of Psychiatry and Human Behavior, Butler Hospital, Brown University, Providence, RI, USA.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Arias
authors.affiliation: 2 Department of Emergency Medicine, Massachusetts General Hospital, Boston MA, USA.
authors.forename: Orianne
authors.initials: O
authors.lastname: Dumas
authors.affiliation: 2 Department of Emergency Medicine, Massachusetts General Hospital, Boston MA, USA.
authors.forename: Ashley F
authors.initials: AF
authors.lastname: Sullivan
authors.affiliation: 3 Department of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Boudreaux
authors.affiliation: 1 Department of Psychiatry and Human Behavior, Butler Hospital, Brown University, Providence, RI, USA.
authors.forename: Ivan
authors.initials: I
authors.lastname: Miller
authors.affiliation: 2 Department of Emergency Medicine, Massachusetts General Hospital, Boston MA, USA.|4 Harvard Medical School, Boston MA, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000328:Adult; D000367:Age Factors; D004636:Emergency Service, Hospital; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
keywords: emergency departments; statistical mediation analysis; structural equation modeling; substance use; suicide attempt