May 12, 2011

Trends in Emergency Department Visits for Drug-Related Suicide Attempts among Females: 2005 and 2009

Suicide ranks 7th in the top 10 leading causes of death for females aged 12 to 65, making suicide prevention among women a public health priority.¹ Although men have higher suicide death rates, women are treated for attempted suicide more often than men.¹ More than 215,000 emergency department (ED) visits involving intentional self-harm were made by females in 2009,¹ and females were involved in 3 out of 5 ED visits for drug-related suicide attempts.² Because suicide attempts are a risk factor for subsequent suicide attempts,³ the ED may represent a key opportunity for mental health intervention.

The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related ED visits in the United States. To be a DAWN case, an ED visit must have involved a drug, either as the direct cause of the visit or as a contributing factor. DAWN data can be used to examine ED visits for drug-related suicide attempts. Although DAWN includes only suicide attempts that involve drugs, these attempts are not limited to drug overdoses. If there is drug involvement in a suicide attempt by other means (e.g., a patient cuts his or her wrists while smoking marijuana), the case is included as drug related. Excluded are suicide attempts with no drug involvement and suicide-related behaviors other than actual attempts (e.g., suicidal ideation or suicidal thoughts); also excluded are suicide attempts involving just alcohol for patients aged 21 or older. This issue of The DAWN Report describes trends in ED visits for drug-related suicide attempts among females from 2005 to 2009.

The number of ED visits for drug-related suicide attempts among females was stable each year from 2005 (92,682 visits) to 2009 (120,418 visits) (Figure 1). By age group, only females aged 50 or older had a statistically significant increase in the number of visits. Among that age group, the number of visits increased 49 percent (from 11,235 visits in 2005 to 16,754 visits in 2009). This increase reflects the overall population growth of women aged 50 or older, rather than an increase in the rate of ED visits for drug-related suicide attempts (23.8 ED visits per 100,000 population in 2005 and 32.3 visits per 100,000 population in 2009).

Figure 1. Emergency Department (ED) Visits for Drug-Related Suicide Attempts among Females, by Age Group: 2005 and 2009

The numbers of ED visits for drug-related suicide attempts among females show that across the drugs examined, most showed modest increases, although only a few differences were statistically significant (Table 1). For example, ED visits for suicide attempts involving illicit drugs remained relatively stable between 2005 and 2009 (14,924 and 16,530 visits, respectively), as did visits for suicide attempts involving pharmaceuticals overall (88,527 and 116,201 visits, respectively). However, visits involving several drugs that treat anxiety and insomnia and specific narcotic pain relievers (i.e., hydrocodone products and oxycodone products) increased significantly during this time period. Findings with respect to these particular drugs are discussed in the subsequent sections.

Among females, ED visits for suicide attempts involving drugs to treat anxiety and insomnia increased 56 percent from 2005 to 2009 (from 32,426 visits to 50,548 visits) (Table 1). Visits involving benzodiazepines—a specific class of drug used to treat anxiety and insomnia—increased 67 percent; visits involving clonazepam, a type of benzodiazepine, increased 84 percent. Statistically significant increases in visits involving clonazepam were seen for two age groups: those aged 21 to 34 and those aged 50 or older (Figure 2).

ED visits for suicide attempts involving zolpidem (e.g., Ambien®)—a drug to treat insomnia—increased 158 percent among females between 2005 and 2009 (from 3,177 visits to 8,190 visits). By age group, statistically significant increases in visits involving this drug were only seen among patients aged 35 to 49 (Figure 2).

Figure 2. Emergency Department (ED) Visits for Female Suicide Attempts Involving Selected Drugs That Treat Anxiety and Insomnia, by Age Group: 2005 and 2009

ED visits for suicide attempts involving narcotic pain relievers in general among females did not show any statistically significant differences between 2005 and 2009; however, there were significant increases involving particular types of these drugs during this period (Table 1). Specifically, visits involving hydrocodone products increased 67 percent (from 4,613 visits in 2005 to 7,715 visits in 2009) and visits involving oxycodone products increased 210 percent (from 1,895 visits in 2005 to 5,875 visits in 2009).

By age group, visits involving hydrocodone products increased significantly only among females in the 35 to 49 age group (Figure 3). Statistically significant increases in visits involving oxycodone products occurred only among female patients aged 21 to 34.

Figure 3. Emergency Department (ED) Visits for Female Suicide Attempts Involving Selected Narcotic Pain Relievers, by Age Group: 2005 and 2009

Increased knowledge is necessary to inform prevention and intervention efforts to reduce the underlying suicidal risk factors in women. Primary care and other health providers who prescribe drugs can monitor the frequency of requested refills, assess medical need, and refer to mental health services when indicated. Likewise, increased awareness of these trends among ED personnel can help ensure that patients are referred to appropriate mental health and social services, which may reduce the repetition of suicide attempts and address underlying health issues (e.g., depression, anxiety disorders, and domestic violence).

The mental and physical health needs of women vary across the life span, and older women represent one of the Nation's fastest growing populations.⁴ Problems such as pain and sleep disorders can lead to increased use of prescription drugs to treat these conditions. Also, older women may experience depression because of health changes or other negative life events. Expanded research on women's aging issues and the potential use of these drugs as a method of, or influence on, suicide attempts is critical.

This page was last updated on October 11, 2010.

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