Sociodemographic characteristics of suicide attempters treated in the emergency department and the effect of psychological care

Abstract

BACKGROUND

Appropriate care for individuals who attempt suicide and are admitted to the emergency department (ED) can prevent future suicidal behavior. It is vital to understand their sociodemographic characteristics and the effects of targeted psychological care.

AIM

To analyze sociodemographic characteristics of suicide attempters treated in the ED and evaluate the efficacy of psychological care.

METHODS

Data from 239 suicide attempters treated in the ED of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture (Hubei Province, China) between January 2021 and February 2025 were divided into 2: Control (n = 108) and psychological care (n = 131). The demographic characteristics and effects of the psychological care were analyzed.

RESULTS

The mean (± SD) age of the 239 patients [114 male (47.7%), 125 female (52.3%)] was 26.25 ± 9.3 years, of whom 122 (45.2%) were single, 117 (48.9%) were married, and 106 (44.4%) had secondary education. Thirty-eight (15.9%) patients had suicidal intent, with a mean of 1.26 ± 0.59 suicide attempts each. Twenty-two (9.21%) patients had a family history of suicide, while 8 (3.34%) had a family history of suicide attempt(s). Before intervention, mean Suicidal Intent Scale scores in the psychological nursing and control groups were 21.57 ± 5.28 and 19.86 ± 5.92, respectively (P > 0.05). After 1 month of nursing intervention, the respective scores were 10.09 ± 1.11 and 16.48 ± 0.87 (P < 0.001); and the re-suicide rates were 11.45% (15/131) and 24.07% (26/108) (P < 0.001).

CONCLUSION

Psychological care significantly reduces suicide risk; EDs should provide comprehensive mental health care.

Key Words: Emergency department; Suicide attempts; Suicide; Psychological nursing; Demographic characteristics

Core Tip: This study analyzed data from 239 suicide attempters admitted to the emergency department (mean age 26.25 years; 52.3% female) to evaluate the efficacy of psychological care. Post-intervention, the psychological care group (n = 131) exhibited significantly reduced Suicidal Intent Scale scores (10.09 vs 16.48) and lower re-suicide rates (11.45% vs 24.07%) compared with the control group (n = 108). The results underscore the critical role of structured psychological interventions in emergency departments to mitigate suicide risk(s), advocating integrated mental health support in acute care settings.

INTRODUCTION

With approximately 800000 deaths annually, suicide is among the leading causes of death globally and poses a significant public health challenge[1,2]; it is the second most common cause of death among individuals between 15 years and 29 years of age[3-5]. A suicide occurs every 40 seconds, contributing to 1.4% of global mortality, making it the 15^th most common cause of death[6]. Approximately one-third of individuals with suicidal thoughts attempt suicide. The incidence of suicide attempts significantly exceeds that of completed suicides, making suicide attempts a more substantial risk factor than mere ideation[7-9]. The heightened risk for suicide after discharge from a psychiatric facility is a significant issue; however, it is exceedingly difficult to assess post-discharge suicide risk in a clinically effective manner[10]. Research suggests that providing effective care after a suicide attempt can reduce the number of re-attempts by as much as 19.8% and decrease suicide fatalities by 1.1%[11]. Suicide risk can be evaluated through a multistage process that includes suicidal thoughts, planning, attempts, and completed suicide. It has been argued that individuals at risk for suicide, who seek help from medical institutions, require psychological intervention and comprehensive psychosocial assessment at the first consultation, a well-planned discharge strategy, and timely, proactive, and coordinated follow-up lasting several months[12]. Research has identified individuals who attempt suicide using violent methods as a high-risk group; however, some studies have suggested that the method of suicide attempt does not necessarily correlate with future suicide attempts[13]. Evidence from various prospective studies suggests that a four-level intervention program is associated with a decline in suicide or suicide incidents (comprising suicide and attempted suicides)[14]. Those who attempted suicide and had high suicidal intent scores demonstrated a stronger intention to die than did those with lower scores, which may have increased their risk for suicide completion[15]. A recent meta-analysis found that the suicide rate was 100 times higher than that of the general population at 3 months after discharge, 60 times higher between 3 and 12 months after discharge, and > 30 times higher for 5-10 years thereafter[16]. As such, early recognition and management of psychological distress and suicidal tendencies are key to preventing suicide-related deaths.

Psychosocial care focuses on addressing the emotional, psychological, and existential needs of patients undergoing palliative care and their families to alleviate grief, fear, and other psychological and social difficulties[17], including home-based psychological support, clinical psychosocial support, and psychotherapy[18]. The primary objectives of emergency departments (EDs) are to preserve life, evaluate patient needs for immediate intervention, and deliver treatment and care[19]. Understanding the origins and elements that perpetuate suicidal behaviors is crucial[20]. The spectrum of suicidal behaviors includes ideation, gestures, attempts, and completed suicide[21]. A significant suicide rate has been reported among individuals discharged from psychiatric facilities[22]. For example, individuals who have attempted or contemplated suicide tend to be more accepting of it than those who have not[23]. Those who have attempted suicide are in the high-risk category[24]. Suicidal thoughts are a crucial stage in the suicide process, preceding a suicide attempt; they are the primary risk factors for suicide completion and can also be life-threatening[25]. Nevertheless, future outcomes remain limited and inconsistent[26-28]. Moreover, EDs assess the physical injuries of individuals who attempt suicide and act as regional referral centers for co-existent mental health issues[29]. As the initial point for diagnosing and managing acute or critically ill patients, EDs are essential for stabilizing patients and ensuring that they receive specialized treatment[30]. As such, the objective of the present study was to evaluate the sociodemographic characteristics of individuals who attempted suicide and were treated in the ED, and to analyze the effects of psychological care to provide more evidence supporting the development of suicide prevention guidelines in the ED.

MATERIALS AND METHODS

Study participants

Data were retrospectively collected from 239 patients who attempted suicide and were treated in the EDs of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture (Hubei Province, China) between January 2021 and February 2025. Patients were divided into 2 groups according to the nursing intervention: Control (routine care, n = 108); and psychological care (n = 131). Patients were divided into the 2 groups based on their personal choices. Demographic characteristics of both groups were collected, analyzed, and compared.

Inclusion and exclusion criteria

The inclusion criteria were as follows: Age ≥ 16 years (to ensure independent capability for self-harm); history of ≥ 1 suicide attempt(s) involving self-harm; and complete clinical data. The exclusion criteria were current participation in other ongoing studies, accidental poisoning, accidental falls, suspicious medical history, and incomplete clinical data.

Ethics approval

This study was approved by the Ethics Committee of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture. Informed written consent was obtained from the patient for publication.

Nursing methods

Routine care (control group): Routine care intervention was based on the hospital’s current standard protocol. Typically, care is limited to acute care for the physical consequences of a suicide attempt, without any mental or psychological assessment or treatment, and without any psychological or social counseling. Patients without physical complications were generally discharged within 24 hours of the completion of physical treatment, and did not receive any outpatient mental health services. Patients were followed-up for 1 month after discharge, and their suicidal behavior was assessed using the same questionnaire as the psychological care group.

Psychological care (intervention group): Patient interviews were conducted in person within 3 days of admission by 2 experienced psychiatrists who received unified training on a standardized psychological intervention protocol based on cognitive behavioral therapy and crisis intervention techniques outlined in the Suicide Prevention Research Collaboration guidelines[31]. The intervention protocol was standardized with a fixed frequency of 3 sessions within the first week of admission (45-60 minutes per session) and 1 follow-up session in the second week, ensuring consistency in both the procedure and content across all participants. The interviews covered information regarding the psychological and social distress underlying suicidal behavior, risk and protective factors associated with the behavior, basic community-specific epidemiology of suicide, repetition of suicidal behaviors, alternative nondestructive coping strategies, and contact/referral options. The patients were followed-up for 1 month after discharge. During each visit, the patients were asked about their feelings and whether they believed that they needed support. If they reported needing support, they were referred to appropriate services. If an individual did not require support but was deemed to be at risk for suicide, referral to local treatment services was recommended. The aim was to “connect” with patients to determine their current state. If a patient died, the cause of death was recorded by relatives or other informants. Any subsequent suicide attempts were recorded if the patient was alive.

Observation indicators

Sociodemographic characteristics: Basic patient information, including age, gender, marital status, employment status, and self-reported suicide history, was collected using questionnaires.

Suicide intent: Suicide intent was assessed using the Suicidal Intent Scale (SIS), which consists of 15 items - 8 examining the circumstances of the attempt and 7 evaluating feelings and thoughts at that time - with scores ranging from 0 (low intent) to 2 (high intent), with a maximum possible score of 30. In addition, re-attempt suicide rates were also calculated[32,33].

Statistical analysis

All the statistical analyses were performed using SPSS version 26 (IBM Corp., Armonk, NY, United States). Quantitative data are expressed as number (n), and qualitative data are expressed as percentage. The χ² test or Fisher’s exact probability test were used to compare the 2 groups. Differences with P < 0.05 were considered to be statistically significant.

RESULTS

Sociodemographic characteristics

Data from 239 patients [mean age, 26.25 ± 9.3 years; 114 male (47.7%), 125 female (52.3%)] were included in the analysis. The marital status of the cohort was distributed as follows: Single (n = 108, 45.2%), married (n = 117, 48.8%), widowed (n = 3, 1.26%), and divorced (n = 6, 2.51%). Education level was distributed as follows: Middle school (n = 106, 44.4%), no education (n = 26, 10.9%), junior high school (n = 59, 24.7%), and non-university diploma (n = 19, 7.95%). Finally, employment status was distributed as follows: Full-time (n = 125, 52.3%), part-time (8.37%), unemployed (6.7%), student (6.28%), homemaker (17.1%), and other employment categories (9.20%) (Table 1).

Table 1 Comparison of sociodemographic characteristics of the patients, n (%).

Variable	Total (n = 239)
Age, mean ± SD	26.25 ± 9.3
Sex
Male	114 (47.7)
Female	125 (52.3)
Marital status
Single	108 (45.2)
Married	117 (48.8)
Widowed	3 (1.26)
Divorced	6 (2.51)
Education
None	26 (10.9)
Primary	59 (24.7)
Secondary	106 (44.4)
Non-university	19 (7.95)
Ethnic
Tujia	92 (38.5)
Miao	25 (10.5)
Han	122 (51.0)
Employment
Full-time	125 (52.3)
Part-time	20 (8.37)
Unemployed	16 (6.7)
Student	15 (6.28)
Homemaker	41 (17.1)
Others	22 (9.20)

The control and psychological care groups consisted of 108 patients and 131 patients, respectively, with a mean ages of 25.96 years and 26.52 years. Males accounted for 48.9% and females 51.1% in the psychological care group, while males accounted for 46.3% and females accounted for 53.7% in the psychological care group, and males accounted for 49.6% and 39.8% in the psychological care and control groups, respectively. There were no significant differences between the groups in terms of sociodemographic characteristics, including age, sex, marital status, and educational level (P > 0.05) (Table 2). The mean lengths of hospital stay for the control and psychological care groups was 48.17 ± 14.09 hours and 51.32 ± 13.99 hours, respectively, with no significant difference between the groups (P > 0.05) (Figure 1A).

Figure 1 Comparison of hospitalization time, post-intervention Suicidal Intent Scale score, and re-suicide rate between the two groups. A: Comparison of hospitalization time between the two patients; B: Comparison of suicide intent scale scores in the two groups after 1 month of nursing intervention in the two groups; C: Comparison of the re-suicide rate of two groups of patients after nursing intervention in one month of nursing. ^aP < 0.001 vs control group. SIS: Suicidal Intent Scale.

Table 2 Comparison of sociodemographic characteristics of the two groups of patients, n (%).

Variable	Psychological nursing group (n = 131)	Control group (n = 108)	P value
Age, mean ± SD	26.52 ± 9.3	25.96 ± 9.2	0.054
Sex			0.715
Male	64 (48.9)	50 (46.3)
Female	67 (51.1)	58 (53.7)
Marital status			0.062
Single	65 (49.6)	43 (39.8)
Married	62 (47.3)	55 (50.9)
Widowed	1 (0.76)	2 (1.85)
Divorced	3 (2.29)	3 (2.78)
Education			0.273
None	11 (8.4)	15 (13.9)
Primary	32 (24.4)	27 (25)
Secondary	60 (45.8)	46 (42.6)
Non-university	10 (7.63)	9 (8.33)
Ethnic			0.069
Tujia	45 (34.35)	47 (43.52)
Miao	13 (9.92)	12 (11.11)
Han	62 (47.33)	60 (55.56)
Employment			0.076
Full-time	72 (55)	53 (49.1)
Part-time	12 (9.16)	8 (7.41)
Unemployed	8 (6.1)	8 (7.41)
Student	8 (6.1)	7 (6.48)
Homemaker	19 (14.5)	22 (20.37)
Others	12 (9.16)	10 (9.26)

Suicide history

Among the 239 patients, approximately 15.9% (n = 38) reported suicidal ideation, with an average of 1.26 ± 0.59 suicide attempts per patient. Furthermore, 9.21% (n = 22) of patients had a family history of suicide, whereas 3.34% (n = 8) had a family history of attempted suicide (Table 3). In the psychological care group, 21 (16.0%) individuals had a history of previous suicide attempts, with 1.27 ± 0.61 previous suicide attempts; the control group had 17 individuals (15.7%) and 1.25 ± 0.5 attempts, respectively. The psychological care group had a family history of suicide in 12 (9.16%) individuals and a family history of attempted suicide in 3 (2.29%), while the control group had 10 (9.26%) and 5 (4.63%), respectively. The 2 groups were comparable in terms of previous suicide attempt history, number of previous suicide attempts, and family history of suicide or attempted suicide (P > 0.05) (Table 4).

Table 3 Suicide history of patients with attempted suicide, n (%).

Variable	Total (n = 239)
Previous suicide attempts	38 (15.9)
Number of previous attempts, mean ± SD	1.26 ± 0.59
Family history of suicide	22 (9.21)
Family history of attempted suicide	8 (3.34)

Table 4 Baseline characteristics of two patients’ suicide history, n (%).

Variable	Psychological nursing group (n = 131)	Control group (n = 108)	P value
Previous suicide attempts	21 (16.0)	17 (15.7)	0.925
Number of previous attempts, mean ± SD	1.27 ± 0.61	1.25 ± 0.58	0.816
Family history of suicide	12 (9.16)	10 (9.26)	0.964
Family history of attempted suicide	3 (2.29)	5 (4.63)	0.538

Suicide intent

Before the intervention, the mean SIS scores in the psychological care and control groups were 21.57 ± 5.28 and 19.86 ± 5.92, respectively, with no statistically significant difference (P > 0.05). One month after the intervention, however, the respective SIS scores were 10.09 ± 1.11 and 16.48 ± 0.87, and the difference was statistically significant (P < 0.001) (Figure 1B).

Re-suicide rate

One month after care, the re-suicide rate in the psychological care group was 11.45% (15/131) and 24.07% (26/108) in the control group; the difference was statistically significant (P < 0.001) (Figure 1C).

DISCUSSION

The proportion of females and males in the present study (52.3% and 47.7%, respectively) was consistent with that reported previously[34,35]. One possible explanation is that females are more emotionally vulnerable and have weaker psychological endurance. They may lack a deeper understanding of situations and resort to suicide when they cannot find a way to solve the problems they encounter. Additionally, introversion and masochistic phenomena among women promote the cohesion of aggression accumulated in a life full of self-sacrifice and burdens, which are easily expressed in the form of suicide under external environmental stimuli. Furthermore, the traditional Chinese concept of “men taking care of external affairs and women taking care of internal affairs” results in women having to complete housework while also being employed; as such, women endure greater mental and psychological pressures. Once this psychological balance is disrupted, suicidal thoughts are likely to emerge[36]. Therefore, caregivers should invest more patience and sympathy in female suicide attempters and provide targeted psychological counseling.

Results of this study indicated that among the 139 suicide attempters, 44.4% had secondary education and 52.3% were employed full-time. A possible explanation is that while secondary education provides a certain knowledge base, the “neither fish nor fowl” attitude may lead to ineffective coping strategies when encountering stressful situations. Full-time workers often encounter higher occupational pressures and financial burdens, which may increase their risk for anxiety and depression. Long working hours and high performance expectations may also lead to an increased psychological burden. Insufficient social support systems and neglect of mental health issues may cause those affected to feel ashamed or helpless when seeking help, thus exacerbating suicidal ideation. This is consistent with findings from previous studies[37,38].

The results also revealed no statistically significant difference in SIS scores between the 2 groups before the intervention (P > 0.05). One month after the intervention, however, the SIS score in the psychological care group was 10.09 ± 1.11, while in the control group was 16.48 ± 0.87, with a statistically significant difference (P < 0.001). Moreover, 1 month after nursing, the re-suicide attempt rate in the psychological care group was 11.45% (15/131) and 24.07% (26/108) in the control group; the difference was statistically significant (P < 0.001). This suggests that psychological care interventions have a better effect, which is consistent with previous research findings[39,40]. A possible explanation is that psychological care intervention, by providing timely emotional support and psychological counseling, helps patients better identify and manage their emotions, alleviating anxiety and depressive symptoms. Furthermore, interventions in the psychological care group may have focused on individual patient needs. This personalized intervention approach makes patients feel valued, thereby increasing their enthusiasm for participating in the intervention and their level of cooperation, ultimately promoting improved mental health.

Existing long-term follow-up studies have mostly focused on the long-term preventive effect of psychological interventions on suicide risk, which provides a basis for the formulation of long-term rehabilitation strategies. This study focused on the short-term follow-up results of patients with suicide attempts in the ED and focused on reflecting the immediate effect of psychological nursing in acute intervention - through one month of observation - and found that psychological nursing can quickly reduce the intensity of suicidal ideation in the short term. For patients who have attempted suicide, the acute phase (especially within 1 month after discharge) is a critical window period with large psychological state fluctuations and a high risk of re-suicide, and this study confirms the feasibility and preliminary effectiveness of implementing targeted psychological care at this stage, and provides data support for the clinical formulation of short-term intervention plans for the “emergency-community” connection.

Limitations

The present study had some limitations, the first of which was its retrospective design, with data collection relying on clinical records, which may have led to information omissions or inaccuracies and, in turn, affected the reliability of the results. Second, this study was conducted at a single hospital; as such, the external validity of the sample may be limited. Therefore, the results may not be applicable to other regions or medical institutions. Third, the grouping of psychological care and control groups in this study was based on patients’ individual choice of care intervention rather than random assignment, which may exacerbate selection bias (e.g., patients who choose to receive psychological care may have a more stable baseline psychological state). Although we compared the basic characteristics of the 2 groups, we could not rule out the influence of potential confounding factors. Notably, despite recognizing the potential impact of individual life events and social support levels on suicidal behavior, this study did not systematically collect data on these variables, such as recent negative life events (e.g., relationship breakdown and unemployment) or the quality of family/community support. Consequently, we were unable to control these confounding factors in the analysis, which may have obscured the true effects of psychological care interventions. Additionally, although multiple demographic characteristics and psychological assessment data were collected, we did not examine other psychological factors that may affect suicidal behavior, such as individual life events, coping mechanisms, and social support levels. This study’s sample has significant regional ethnic specificity, and the high proportion of Tujia and Miao ethnic groups is directly related to the ethnic composition of the research area. The cultural traditions and living customs of different ethnic groups may affect the external applicability of the research results. It is noteworthy that the sample in this study was mainly Tujia and Miao, who have unique ethnic cultures and social support models in the Enshi region. These factors may affect patients’ psychological states and suicidal intentions. Finally, the follow-up period was only 1 month, which is relatively short and may not have been sufficient to evaluate the long-term effects of psychological care interventions. However, this short-term design also provides a unique reference value for ED-based short-term interventions, providing real-world evidence for the effectiveness of psychological care in stabilizing the acute psychological crisis of suicide attempters during the critical post-attempt period (1 month), which is crucial for preventing immediate re-suicide attempt risk and laying a foundation for subsequent long-term interventions. Future studies should incorporate assessments of life events and social support levels to better control confounding variables and improve the robustness of the research findings. Future studies should extend the length of follow-up to observe changes in patients’ mental health and the risk for re-suicide over a longer period.

CONCLUSION

In summary, the intervention effect of psychological care significantly reduced suicidal ideation and suicide rates. Future psychological care programs should incorporate stratified intervention strategies tailored to specific population characteristics. For female patients, interventions can focus on addressing gender-related stressors, such as social role conflicts and emotional pressure, by integrating gender-sensitive counseling techniques to enhance emotional regulation capabilities. For single individuals, efforts should be made to strengthen social connection building, including organizing peer-support groups and linking community resources to mitigate feelings of isolation. Future research should continue to explore and optimize psychological care measures for suicide attempters to better address their mental health needs.