Emergency Department Surveillance of Nonfatal Suicide-Related Outcomes

Suicide is a leading cause of death in the United States. In 2020, nearly 46,000 people died by suicide.1 Additionally, every year, millions of Americans seriously think about suicide, make a plan for suicide, or attempt suicide.2

CDC is using new and existing data to better understand, monitor, and prevent suicide and suicidal behavior.

CDC funds the Emergency Department Surveillance of Nonfatal Suicide-Related Outcomes (ED-SNSRO) cooperative agreement to help states increase the timeliness of surveillance of nonfatal suicide-related outcomes. Collecting near real-time data on nonfatal suicide-related outcomes—such as suicidal ideation and suicide attempts —can help states rapidly track and respond to changing patterns in suicidal behavior.

ED-SNSRO supports 10 states:
  • Louisiana
  • Maine
  • New York
  • Ohio
  • Oregon
  • Rhode Island
  • Utah
  • Vermont
  • Washington
  • West Virginia

States use ED-SNSRO funding to:

  • Increase the timeliness of reporting nonfatal suicide-related outcomes, and
  • Disseminate surveillance findings to key stakeholders working to prevent or respond to suicide and nonfatal suicidal behaviors.

What is syndromic surveillance?

Syndromic surveillance provides public health officials with a timely system for detecting, understanding, and monitoring health events. By tracking symptoms of patients in emergency departments—before a diagnosis is confirmed—public health can detect unusual levels of illness to determine whether a response is warranted.

Read more about CDC’s National Syndromic Surveillance Program (NSSP).

Visit CDC’s Suicide Prevention webpage to find out more about what CDC is doing to prevent suicide.

Success Stories
Oregon Uses Syndromic Surveillance to Monitor and Respond to a Suicide Cluster

In May 2021, Oregon’s National Violent Death Reporting Systemexternal icon revealed that a cluster of suicides occurred in 2020 by means of ingesting a chemical. Prior to 2020, this chemical had only been identified as the means of suicide in Oregon in one 2018 case. However, the chemical was used in 14 suicide deaths in 2020, and in two suicide deaths* in 2021. Oregon’s ED-SNSRO project provided the capacity to actively monitor morbidity and mortality data for unusual activity.

Oregon’s ED-SNSRO team reviewed medical examiner narratives for all cases, noting similarities across cases and establishing a monitoring process to identify any new cases. The Oregon Health Authority (OHA) tracked poisonings involving this chemical across data systems, developed and distributed data briefs for emergency medical services, local medical examiners, and emergency departments, and alerted suicide prevention coordinators in the affected counties. OHA also created a fact sheet to help emergency medical services and emergency departments identify and treat these poisonings and a corresponding fact sheet for medical examiners on what to look for at the scene of death and in autopsies to identify these poisonings.

OHA requested that Oregon Poison Control and state hospital systems document and report all poisonings involving this chemical in their data systems. OHA also contacted the Centers for Disease Control and Prevention (CDC), the Environmental Protection Agency (EPA), and the Food and Drug Administration (FDA) to alert them to this suicide cluster and discuss national-level action. The availability of this emerging, near real-time data and implications allowed OHA to act quickly to enact new surveillance protocols and alert systems that were put in place through ED-SNSRO support.

*At the time this story was written.

Rhode Island Uses Syndromic Surveillance to Respond to Increase in Youth Suicidal Behavior
Rhode Island

In Rhode Island, Hasbro’s Children’s Hospital Pediatric Psychiatry Emergency Services worked with the Rhode Island Department of Health (RIDOH) to investigate a suspected increase in the number of young people seen in emergency departments for suicidal ideation and attempts, particularly those involving drug overdoses. The ED-SNSRO team reviewed the data and quickly determined that there was an increase in suicide attempts involving over-the-counter (OTC) medication among girls under 18. A multi-agency team used these ED-SNSRO data to implement a campaign across Rhode Island to help prevent intentional overdoses with OTC medication. The campaign is called Over-the-Counter does not mean On-the-Counterpdf iconexternal icon. It includes social media, TV ads, and print ads (in English, Spanish, and Portuguese). The health department also provides medication lock bags and pill bottle timer caps to the public at no cost. The agencies involved in the campaign received over 1,000 requests for medication lock bags within the first few weeks of its launch. The immediate impact of this data-to-action campaign would not have been possible without ED-SNSRO. ED-SNSRO syndromic data allowed RIDOH to quickly respond to emerging local needs with a focused community response.

Multiple agencies collaborated to make these activities possible and successful, including:

  • Rhode Island Department of Health
    • Youth Suicide Prevention Team
    • ED-SNSRO Team
  • Hasbro Children’s Hospital’s Pediatric Psychiatry Emergency Services
  • Rhode Island’s Executive Office of Health and Human Services
  • Rhode Island Department of Education
  • Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals
  • South County Regional Prevention Coalition
  • Kent County Prevention Coalition
Utah Uses Syndromic Surveillance to Understand COVID-19 Impact on Suicide-Related Outcomes

Suicide is one of the leading causes of death in Utah. In 2020, Utah Department of Health’s Incident Command System (ICS)—which was in place to deal with the high number of opioid overdoses — became concerned about the impact of COVID-19 restrictions on mental health and suicide. However, most suicide-related data sources, such as death certificates and hospitalizations, were not timely enough to understand trends during and related to COVID-19. Fortunately, ED SNSRO’s syndromic surveillance can detect changes in the number of people seeking emergency medical services for suicide-related behavior and can help focus interventions once issues are identified.

ICS and the state’s COVID Suicide Surveillance Committee analyzed trends in nonfatal suicide-related syndromic surveillance data. Analysis of data from 2019, 2020, and 2021 revealed that the average number and rate of suicide attempts was higher after COVID-19 restrictions were put in place. The suicide attempt rate was highest among 10–17-year-olds.

Timely syndromic surveillance from ED-SNSRO of suicide-related outcomes provided a way to analyze current trends and answer media and partner requests about how COVID-19 impacted suicide-related outcomes in Utah. Results were shared with suicide prevention personnel in bi-weekly meetings and included in a report on social and behavioral healthpdf iconexternal icon during COVID-19 in Utah. Participation in ED-SNSRO strengthened collaboration among staff from multiple programs within the health department and external partners from behavioral health and healthcare systems.

  1. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2020 on CDC WONDER Online Database, released in 2021.
  2. Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health(HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. 2020. Retrieved from https://www.samhsa.gov/data/external icon