(781) Association Between Social Determinants of Health and Youth ICU Admission for Suicide Attempt

Introduction: Youth who experience adverse childhood events (ACEs) are at higher risk for suicide attempt (SA), and social determinants of health (SDOH) and ACEs are interconnected. However, many measures of ACEs or SDOH are not included in large inpatient pediatric databases or death records, thus the association between severe youth SA requiring ICU admission and SDOH is unknown. We aimed to describe SDOH and ACEs of youth with SA requiring ICU admission compared to ward admission to identify youth at highest risk for serious suicide attempts.

Methods: We conducted a retrospective cohort study of patients aged 5–24 years admitted to two pediatrics centers for SA from 2010–2022 and included index ward and ICU admissions for SA. We compared the prevalence of SDOH measures (housing instability, food insecurity, unemployed caregiver, incarceration, incarcerated family member, transportation barriers, sexual or physical assault, directly witnessed violence, CPS involvement) between youth admitted to the ICU vs ward for SA, using log-binomial regression.

Results: Of 1298 youth admitted with SA, history of sexual or physical assault (35.7%, n=464) and history of CPS involvement (27.6%, n=358) had the highest positive screen. Screening for measures of SDOH was inconsistent, with 6.8% (n=88) not screened for any measure of SDOH, and 94.8% (n=1230) not screened for at least one of the measured SDOH. ICU admission occurred in 47.5% (n=617) of SA admissions, with in-hospital mortality of 8.1%. ICU SA admissions had higher prevalence of youth with unemployed caregivers (11.3% vs 6.5%, risk ratio [RR] 1.64, 95% CI 1.07–2.52), youth actively incarcerated or with a history of incarceration (7.5% vs 5.3%, RR 1.63, 95% CI 1.06–2.51), and youth with an incarcerated immediate family member (7.8% vs 5.0%, RR 1.68, 95% CI 1.09–2.58).

Conclusions: Investigations into SDOH characteristics of youth with SA requiring ICU hospitalization is limited by low inpatient screening rates for specific measures of SDOH. In-hospital mortality of youth SA is high, warranting further investigation into risk factors for severe youth SA. Standardized SDOH screening may improve understanding of this population and inform strategies for youth SA prevention.