JAACAP Open. 2026 Oct;4(5):
823-832
Objective: To examine national trends in suicidality-related (intentional self-harm, self-inflicted injury, and suicide attempt) emergency department (ED) visits among US children and adolescents between 2016 and 2022 and describe demographic and psychiatric correlates across age groups.
Method: Data were obtained from the 2016 to 2022 Nationwide Emergency Department Sample (NEDS) for patients aged 5 to 19 years with suicidality-related ICD-10-CM codes. Weighted national estimates, demographics, and psychiatric comorbidities were compared across age groups (5-9, 10-14, and 15-19 years). Temporal trends were evaluated using Daniel's test for trend, with p < .05 considered significant.
Results: There were an estimated 1,100,785 suicidality-related ED visits (intentional self-harm 61%, self-inflicted injury 39%, suicide attempt 9%). The number of visits increased significantly among age group 10 to 14 for all diagnoses (p ≤ .01) and among age group 15 to 19 for suicide attempts only (p = .003). Female patients (74.7%) accounted for most visits. Depression (45.3%) and anxiety (21.6%) were the most common comorbidities.
Conclusion: Suicidality-related ED visits among US youth remain alarmingly high, especially among young adolescents. The predominance of depression, anxiety, and female patient representation underscores the need for early, community-based mental health interventions and post-ED follow-up care.
Clinical guidance: • Screen earlier and repeatedly. Incorporate routine suicide risk screening beginning in late elementary school (ages 9-10), especially during well-child visits, school physicals, and emergency department encounters, even when presenting complaints are nonpsychiatric.• Treat self-harm as a high-risk signal. Any self-inflicted injury-regardless of stated intent-should trigger a structured suicide risk assessment, safety planning, and close follow-up, as self-harm often precedes suicide attempts.• Address comorbid depression, anxiety, and trauma aggressively. Early identification and evidence-based treatment (eg, cognitive behavioral therapy, dialectical behavior therapy-informed skills, trauma-focused care) should be prioritized, with coordinated family involvement when developmentally appropriate.• Strengthen transitions of care after emergency department visits. Ensure rapid outpatient follow-up (within 7 days), clear communication with caregivers, and linkage to school- and community-based supports, particularly for preteens and adolescents from low-income households.
Diversity & Inclusion Statement: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
Keywords: ICD-10; adolescent mental health; emergency department utilization; pediatric suicidality; suicide attempts and self-harm