Suicidal Ideation Among Adolescents With Confirmed Maltreatment: Insights From the 2016-2020 Nationwide Emergency Department Sample

Objective: Among adolescents, maltreatment is an established risk factor for suicidal ideation (SI). This study tests the relationship between different forms of maltreatment and SI encountered in emergency department (ED) settings. Method: We used cross-sectional data from a nationally representative sample of ED visits from 2016 to 2020 that involved adolescents 12 to 17 years of age. We sought to characterize the relationship between forms of maltreatment and SI, to explore the relationship between perpetrator type and SI, and to analyze patterns in SI by maltreatment type. Results: SI was significantly higher among ED visits with maltreated adolescents (7.05%) relative to ED visits without confirmed maltreatment (2.92%; p < .001). SI was documented most in cases of psychological maltreatment (32.85%), followed by multiple forms of maltreatment (24.72%), neglect (6.73%), physical abuse (6.43%), and sexual abuse (5.20%) (p < .001). SI was associated with payer in cases of neglect (p = .038) and sexual abuse (p < .001), sex in cases of physical abuse (p = .022) and sexual abuse (p = .016), and urban–rural status in cases of physical abuse (p = .044). Perpetrator type was differentially associated with SI (p < .001). A significant trend in SI-related ED visits was found by year (odds ratio = 1.12, p = .003) when adjusting for maltreatment type and demographic characteristics. Conclusion: Study findings present new evidence on the relationship between maltreatment and SI encountered in ED settings. Suicide risk assessment for adolescents with maltreatment histories presenting to the ED is important for supporting the psychological health of this vulnerable population. Plain language summary: Using a national sample of emergency department visits from 2016–2020, this study evaluates the relation between abuse and suicidal ideation in adolescents presenting to the emergency department (ED). Suicidal ideation was higher in youth with psychological abuse who were seen in the ED relative to other forms of abuse or neglect. These findings draw attention to the need for suicide screening and appropriate intervention in youth with a history of maltreatment.