Elizabeth D Ballard1, Mary Cwik2, Carla L Storr3, Mitchell Goldstein4, William W Eaton5, Holly C Wilcox6. 1. Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA. 2. Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 3. Department of Family & Community Health, University of Maryland School of Nursing, Baltimore, MD, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 4. Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 5. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 6. Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: hwilcox1@jhmi.edu.
Abstract
OBJECTIVES: Suicide is a leading cause of death; unfortunately most individuals at risk for suicide are not identified, assessed or treated by the mental health system. Investigating medical healthcare utilization among individuals with a history of suicide attempt may identify alternative settings for case finding and brief intervention. METHODS: The study sample (n=1422, 58% female, 72% African-American) is from a prospective cohort of adults (27-31 years) who participated in a randomized trial of school-based interventions. Logistic regression evaluated the relationship between lifetime history of suicide attempt with past year medical service utilization and selected self- reported health conditions, controlling for lifetime Major Depressive Disorder (MDD), demographic factors, health insurance status and employment. RESULTS: A suicide attempt history was associated with past year emergency department medical visits [aOR 1.51, 95% CI 1.04-2.18, P=.03], but not primary care visits or inpatient hospitalization, when controlling for MDD and other covariates. Severe headaches and chronic gastrointestinal conditions were also associated with lifetime suicide attempt [aOR 1.50, 95% CI 1.03-2.17 and aOR 1.67, 95% CI 1.06-2.63, respectively]. CONCLUSIONS: Suicide prevention, including universal screening and brief intervention, is indicated in emergency department settings. Restricting screening to subgroups, such as those individuals presenting with depression, may miss at-risk individuals with somatic concerns.
OBJECTIVES: Suicide is a leading cause of death; unfortunately most individuals at risk for suicide are not identified, assessed or treated by the mental health system. Investigating medical healthcare utilization among individuals with a history of suicide attempt may identify alternative settings for case finding and brief intervention. METHODS: The study sample (n=1422, 58% female, 72% African-American) is from a prospective cohort of adults (27-31 years) who participated in a randomized trial of school-based interventions. Logistic regression evaluated the relationship between lifetime history of suicide attempt with past year medical service utilization and selected self- reported health conditions, controlling for lifetime Major Depressive Disorder (MDD), demographic factors, health insurance status and employment. RESULTS: A suicide attempt history was associated with past year emergency department medical visits [aOR 1.51, 95% CI 1.04-2.18, P=.03], but not primary care visits or inpatient hospitalization, when controlling for MDD and other covariates. Severe headaches and chronic gastrointestinal conditions were also associated with lifetime suicide attempt [aOR 1.50, 95% CI 1.03-2.17 and aOR 1.67, 95% CI 1.06-2.63, respectively]. CONCLUSIONS: Suicide prevention, including universal screening and brief intervention, is indicated in emergency department settings. Restricting screening to subgroups, such as those individuals presenting with depression, may miss at-risk individuals with somatic concerns.
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