Background: One out of every 5 teens has had mental illness with severe impairment in their lifetime. Furthermore, from 2008-2015 the number of hospitalizations for suicidal ideation (SI)/suicide attempt (SA) more than tripled and the percentage of all hospitalizations doubled for SI/SA across 31 children’s hospitals. Given the increasing burden observed in the hospital setting, further characterization of this patient population is needed.
Methods: Retrospective chart review of patients 13 years and older hospitalized for ingestion, discharged from the hospital medicine service at Children’s Hospital of Wisconsin from 5/1/17 to 9/30/17. Descriptive statistics and Pearson chi-square analysis performed.
Results: 282 encounters were reviewed with 74 encounters found to be due to ingestion. Of those 74 hospitalizations, 68% stated reason for ingestion was SA, 14% to get high, relieve pain or try to sleep, and 19% gave no clear reason. In terms of substances ingested, 34% were exclusively over the counter medications (OTCs), 46% exclusively prescription medications, 4% both OTC and prescription medications, 7% exclusively alcohol, 3% exclusively illicit drugs (1 of heroin and 1 of MDMA) and 7% identity undetermined. Analyzing the 50 SA ingestions demonstrated that a significant proportion ingested either psychiatric medications (28%) or OTC medications (36%). Of the 39 SA encounters with primary care physician (PCP) records in our electronic health record (EHR), less than a third had screening for suicidal ideation by their PCP in the year prior (including use of the PHQ-9 screening tool), 19% did not see their PCP in the year prior and 33% saw their PCP either for a routine visit (15%) or other reason (18%) but did not have SI screening documented. SA ingestions were significantly more likely to have history of prior SA (p=0.03). Of ingestions where a different reason was given: 80% had no known history of SAs and 20% were seen by a medical provider for a prior SA. Compared to the SA ingestions: 44% had no known history of SAs, 44% were seen for a prior SA and 12% reported a prior SA during this hospitalization but had not been seen by a medical provider for that SA. Review of these 6 encounters in which the patient reported a prior SA found 2 patients had no PCP visit over the last year, 2 had seen their PCP but no SI screening was documented and 2 did not have PCP records in our EHR.
Conclusions: The majority of SA ingestion patients ingested what is available in the home including their psychiatric medications and OTCs, suggesting caution should be advised when allowing teens access to those medications. Moreover, given the significant number of teens not being screened for SI by PCPs, screening should be instituted in non-traditional settings such as in the hospital, regardless of reason for hospitalization.