Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Ruth Bush, PhD, MPH, FAMIA, Chairperson; Michael Terry, DNP, FNP, PMHNP, committee member; Brenda Boone, PhD, RN, CRN, committee member


suicide risk assessment, suicide mortality, emergency department


Purpose The purpose of this retrospective comparative study is to describe relationships among biological, psychological, sociocultural factors and emergency department (ED) care among discharged ED patients and describe the association of these variables with subsequent suicide mortality.

Rationale Identifying patients who are most at risk of suicide mortality post ED discharge can focus resources, refine interventions, and prevent suicide. Additionally, recognizing patterns of ED care including ordering of a psychiatric evaluation and disposition status can provide data for potential practice changes.

Background Suicide is the 10th leading cause of death in the United States and has been since 2008. Suicide is preventable if those at risk are identified and provided with timely interventions. Many victims of suicide have interactions with healthcare providers in the year prior to suicide making the ED a critical setting for the detection of suicidal ideation and suicide prevention.

Method This retrospective comparative study matched data from patient cases treated in one of four EDs of an integrated healthcare system from March 1, 2015 to March 31, 2019 with San Diego County Medical Examiner’s suicide data from March 1, 2015 to March 31, 2020.

Findings The incidence of suicide was 33 per 100,000 and 67.8% of suicide mortality occurred within 1 year of ED discharge. In this study, the majority of cases were White, non-Hispanic/non-Latino, English speaking males in their late 40s with 3 or more ED visits, without a suicide-related primary diagnosis and reported residence in the East County.

Implications for Research The rate of suicide has remained static for decades despite community outreach programs and implementation of suicide screening in the ED. It is imperative to understand the relationships biological, psychological, and sociocultural factors and ED care have on suicide mortality in high-risk patients.

Document Type

Dissertation: Open Access



Available for download on Monday, May 01, 2023

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