Analysis of Substance Use and Suicidal Ideation in Midwestern Frontier and Non-Frontier Locations


Emergency departments represent a unique opportunity to intervene in mental health and substance use crises. For people residing in frontier and remote locations (greater than 60 min from cities of 50,000 people), emergency departments may be a critical source of mental healthcare, given limited local access to mental health professionals. The purpose of the current study was to investigate emergency department usage for substance use disorders and suicidal ideation in patients residing in frontier and non-frontier locations.


South Dakotan syndromic surveillance data from 2017-2018 were obtained for this cross-sectional study. ICD-10 codes were queried to identify substance use disorder and suicidal ideation during emergency department visits. Differences in substance use visits were investigated in frontier and non-frontier patients. Additionally, logistic regression was used to predict suicidal ideation in cases and age- and sex-matched controls.


Frontier patients had a higher percentage of emergency department visits with a diagnosed nicotine use disorder. Conversely, non-frontier patients were more likely to use cocaine. Substance use for other categories of substances was similar between the frontier and non-frontier patients. Alcohol, cannabis, nicotine, opioid, stimulant, and psychoactive substance diagnoses all increased the patient’s odds of receiving a suicidal ideation diagnosis. Further, residing in a frontier location also increased the odds of suicidal ideation.


Patients residing in frontier locations differed in some forms of substance use disorders and in suicidal ideation. Increasing access to mental health and substance use treatment may be critical for those residing in these remote locations.

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