INTRODUCTION: The time following emergency department (ED) discharge is a high-risk period for suicidal behavior. This study examined correlates of suicidal behavior patterns over one-year follow-up among adults presenting to the ED with active suicidal thoughts and behaviors.

METHODS: Participants were n = 863 adults presenting to the ED with active suicidal thoughts and behaviors followed for one year post-discharge. Participants were categorized into four suicidal behavior groups: none (no suicidal behavior at baseline or follow-up), worsening (no suicidal behavior at baseline but at follow-up), improving (suicidal behavior at baseline but not follow-up), or persistent (suicidal behavior at both timepoints). We used binary logistic regression models to compare persistent versus improving and worsening versus none groups to examine factors that distinguished groups with the same baseline but different follow-up suicidal behavior.

RESULTS: The most common suicidal behavior patterns were none (52.7%, n = 455) or improving (24.7%, n = 213). Risky alcohol use and previous psychiatric inpatient hospitalization distinguished participants in the worsening group from the none group. None of the factors distinguished the improving from the persistent group.

CONCLUSIONS: Individuals with active suicidal ideation, alcohol use, and past psychiatric inpatient hospitalization may require additional support following ED discharge to prevent future suicide attempts.