Costs of adolescent suicidality: A comparison of state, regional, and national patterns

Background: Adolescent suicidality is a complex public health problem complicated by varying state and regional patterns. To facilitate prevention efforts, this project compares state and regional patterns with national patterns.

Method: Suicides and non-fatal self-inflicted injuries were defined by ICD-10 and ICD-9-CM classification schemes. NCHS mortality data were used to determine average annual suicide counts and rates, 1999-2003. Nationwide hospitalization for suicide attempts were obtained from the 2003 Nationwide Inpatient Survey, part of the Healthcare Cost and Utilization Project (HCUP). State hospitalized suicide attempts were obtained from the 2003 State Inpatient Database, also part of HCUP; from state health departments; or estimated from previous state self-inflicted morbidity and mortality data. Medical and work-loss unit costs were computed in year 2005 dollars, adjusted to state-specific prices, and multiplied by corresponding incidence.

Results: From 1999-2003, suicide was the third leading cause of death for adolescents age 15-19, on average, 1569 suicides per year. In 2003, approximately 23,621 adolescents age 15-19 were hospitalized for suicide attempt, at a rate greater than 125 per 100,000. National costs per case are approximately $6900 medical costs for hospitalized attempts and $4500 medical costs for fatalities. Work loss costs include $9700 for hospitalized attempts and nearly $1.8 million for fatalities. States and regions vary widely in gender, mechanism, and costs patterns.

Conclusion: Data suggest the severity of the problem and appropriate prevention efforts are interconnected with gender and geographical patterns, and with reciprocal relationships between medical or work loss costs and the methods associated with suicide acts.