096 - Does Neighborhood Predict Risk? Examining Associations between Child Opportunity Index and Risk Factors for Suicide among Pediatric Emergency Department Youth

Publication Number: 96.4781

Rachel Cafferty, University of Colorado School of Medicine, Denver, CO, United States; Mairead Dillon, University of Colorado School of Medicine, Denver, CO, United States; Lilliam Ambroggio, Children's Hospital Colorado, Aurora, CO, United States; Bruno J. Anthony, University of Colorado School of Medicine, Denver, CO, United States; Maya Haasz, University of Colorado School of Medicine, Aurora, CO, United States; Sean T. O'Leary, University of Colorado School of Medicine, Denver, CO, United States

Background: The Child Opportunity Index (COI) is a multidimensional measure of neighborhood opportunity. Low COI (residing in a low-opportunity neighborhood) is associated with increased Emergency Department (ED) utilization and less favorable mental health outcomes in youth. The relationship between COI and independent risk factors for youth suicide is not well-established.

Objective: To examine associations between COI and risk factors for suicide among youth with a positive suicide screen in the ED.

Design/Methods: This retrospective cohort study included youth, ages 10-18 years old, who had a positive suicide screen in the ED and subsequently completed a risk questionnaire between July 2020 and June 2024. Data were linked to the COI 3.0 scores for 2021. The primary predictor was COI (quintile rank for overall state-normed COI and within each COI domain: education, health/environment, social/economic). The primary outcome measures (i.e., suicide risk factors) were: (1) transgender/non-binary identity, (2) non-heterosexual orientation, (3) bullying, (4) experiences of violence, (5) access to firearms, (6) non-suicidal self-injury, and (7) substance use. We performed multivariable logistic regression modeling, adjusting for age.

Results: Among 872 youth, the median age was 15 years. Most youth were female, White, Hispanic, and publicly insured; 23% reported bullying at school, 25% reported feeling unsafe with an adult, and the most used substance was marijuana (13% weekly or more) (Table 1). Few patients (8%) resided in the ‘very high’ quintile of state-normed COI neighborhoods; many (42%) resided in the ‘very low’ quintile of state-normed COI neighborhoods. There were no significant associations between COI and gender identity, sexual orientation, bullying, violence, non-suicidal self-injury, or substance use (Figure 1). There was a statistically significant association between COI and access to firearms across all COI domains (Figure 2). In the social/economic domain, higher COI quintile, compared to ‘very low’ COI (referent group), was associated with incrementally increased odds of access to firearms: low (OR 2.38; 95% CI: 1.32, 4.26), moderate (OR 2.40; 95% CI: 1.43, 4.08), high (OR 4.58; 95% CI: 2.50, 8.37), very high (OR 6.46; 95% CI: 3.47, 12.1).

Conclusion(s): In this cohort of youth with elevated suicide risk, higher COI was associated with increased odds of access to firearms. COI was not associated with other risk factors for suicide. Future multicenter research examining the relationship between COI, firearm access, and suicide risk in youth are needed.

Table 1. Self-Reported Psychosocial Risk Factors among Pediatric Emergency Department Youth with a Positive Suicide Screen
Table 1_Risk Factors.pdf

Figure 1. Associations between State-normed Overall Child Opportunity Index and Suicide Risk Factors in Youth
Figure 1_COI and Risk Factors.pdf

Figure 2. Associations between State-normed Child Opportunity Index Domains and Access to Firearms among Youth with Elevated Suicide Risk
Figure 2_COI domains and Firearms.pdf