Anne E Rhodes1,2,3,4, Michael H Boyle3,4,5, Jeffrey A Bridge6,7, Mark Sinyor1,8,9, Laurence Y Katz10,11, Kathryn Bennett3,4,5, Amanda S Newton12, Paul S Links4, Lil Tonmyr13, Robin Skinner13, Amy Cheung1,8,9, Jennifer Bethell14, Corine Carlisle15,16. 1. 1 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario. 2. 2 The Institute for Clinical Evaluative Sciences, Toronto, Ontario. 3. 3 The Offord Centre for Child Studies, Hamilton, Ontario. 4. 4 Department of Psychiatry and Behavioural Neuroscience Sciences, McMaster University, Hamilton, Ontario. 5. 5 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario. 6. 6 Center for Suicide Prevention and Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA. 7. 7 The Ohio State University College of Medicine, Columbus, OH, USA. 8. 8 Sunnybrook Health Sciences Centre, Toronto, Ontario. 9. 9 Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario. 10. 10 Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba. 11. 11 Child and Adolescent Mental Health, Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba. 12. 12 Department of Pediatrics, University of Alberta, Edmonton, Alberta. 13. 13 Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa. 14. 14 The Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario. 15. 15 Department of Psychiatry, University of Toronto, Toronto, Ontario. 16. 16 Department of Psychiatry, Hospital for Sick Children (SickKids), Toronto, Ontario.
Abstract
OBJECTIVE: Prior year medical care was compared among youth dying by suicide to their peers. Effect modification of these associations by age or place of residency (rural versus larger community sizes) was examined in a large, medically insured population. METHOD: This population-based case control study used data from the Office of the Chief Coroner in Ontario, Canada, linked to health care administrative data to examine associations between medical care for mental health or other reasons (versus no medical care) and suicide. Decedents ( n = 1203 males and n = 454 females) were youth (aged 10 to 25 years) who died by suicide in Ontario between April 2003 and March 2014, inclusive. Peers of the same ages were frequency matched to decedents on sex and place of residency. Logistic regression was used to calculate odds ratios and 95% confidence intervals and to test effect modification. RESULTS: Associations with mental health care were stronger in decedents than peers with a gradation of care (i.e., outpatient only, emergency department [ED], inpatient care) in both sexes. However, these associations were weaker among youth living in rural communities. Furthermore, older males (aged 18 to 25 years) were less likely than younger males (aged 10 to 17 years) to access the ED (ambulatory care only). This decrease was observed in rural and larger communities alongside no increase in medical care for other reasons. CONCLUSIONS: Geographical and age-related barriers to mental health care exist for youth who die by suicide. Preventive efforts can address these barriers, intervening early and integrating services, including the ED.
OBJECTIVE: Prior year medical care was compared among youth dying by suicide to their peers. Effect modification of these associations by age or place of residency (rural versus larger community sizes) was examined in a large, medically insured population. METHOD: This population-based case control study used data from the Office of the Chief Coroner in Ontario, Canada, linked to health care administrative data to examine associations between medical care for mental health or other reasons (versus no medical care) and suicide. Decedents ( n = 1203 males and n = 454 females) were youth (aged 10 to 25 years) who died by suicide in Ontario between April 2003 and March 2014, inclusive. Peers of the same ages were frequency matched to decedents on sex and place of residency. Logistic regression was used to calculate odds ratios and 95% confidence intervals and to test effect modification. RESULTS: Associations with mental health care were stronger in decedents than peers with a gradation of care (i.e., outpatient only, emergency department [ED], inpatient care) in both sexes. However, these associations were weaker among youth living in rural communities. Furthermore, older males (aged 18 to 25 years) were less likely than younger males (aged 10 to 17 years) to access the ED (ambulatory care only). This decrease was observed in rural and larger communities alongside no increase in medical care for other reasons. CONCLUSIONS: Geographical and age-related barriers to mental health care exist for youth who die by suicide. Preventive efforts can address these barriers, intervening early and integrating services, including the ED.
Entities:
Keywords:
Ontario; access to care; adolescence; health care utilization; mental health services; suicide
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