Timothy Schmutte1, Mark Olfson2, Ming Xie3, Steven C Marcus4. 1. Department of Psychiatry, Program for Recovery and Community Health, Yale University (TS), Westport, CT. Electronic address: timothy.schmutte@yale.edu. 2. Department of Psychiatry, New York State Psychiatric Institute, Columbia University (MO), New York City, NY. 3. Department of Psychiatry, University of Pennsylvania (MX), Philadelphia, PA. 4. School of Social Policy & Practice, University of Pennsylvania (SCM), Philadelphia, PA.
Abstract
OBJECTIVE: Emergency department visits for self-harm and suicidal ideation have increased for US older adults. The purpose of this study was to examine discharge disposition, clinical recognition of mental disorder, and 30-day follow-up mental health outpatient care of older adults treated in emergency departments for suicide attempt (SA), suicidal ideation (SI), or deliberate self-harm (DSH). METHODS: Retrospective cohort analysis using 2015 Medicare claims for adults ≥65 years of age with suicide-related emergency encounters (N = 52,383). Demographic, clinical, and service use characteristics from claims were merged with county-level Area Health Resource File data. Rates and adjusted risk ratios were assessed for discharge to the community, mental health diagnosis in the emergency department, and outpatient mental health visits with 30 days after the emergency encounter. RESULTS: Encounters for SA (7.8%) and SI (17.2%) were less likely than those for DSH (29.1%) to be discharged to the community. Among community discharges, SA (95.6%) and SI (95.1%) encounters were more likely than DSH (52.3%) encounters to be diagnosed with a mental disorder in the emergency department. Encounters for SA (52.1%) and SI (59.9%) were also more likely than DSH (31.3%) encounters to receive follow-up mental care. CONCLUSIONS: Although most older adults treated in EDs for suicide-related reasons are hospitalized, a substantial proportion of patients discharged back to the community do not receive follow-up mental healthcare within 30 days.
OBJECTIVE: Emergency department visits for self-harm and suicidal ideation have increased for US older adults. The purpose of this study was to examine discharge disposition, clinical recognition of mental disorder, and 30-day follow-up mental health outpatient care of older adults treated in emergency departments for suicide attempt (SA), suicidal ideation (SI), or deliberate self-harm (DSH). METHODS: Retrospective cohort analysis using 2015 Medicare claims for adults ≥65 years of age with suicide-related emergency encounters (N = 52,383). Demographic, clinical, and service use characteristics from claims were merged with county-level Area Health Resource File data. Rates and adjusted risk ratios were assessed for discharge to the community, mental health diagnosis in the emergency department, and outpatient mental health visits with 30 days after the emergency encounter. RESULTS: Encounters for SA (7.8%) and SI (17.2%) were less likely than those for DSH (29.1%) to be discharged to the community. Among community discharges, SA (95.6%) and SI (95.1%) encounters were more likely than DSH (52.3%) encounters to be diagnosed with a mental disorder in the emergency department. Encounters for SA (52.1%) and SI (59.9%) were also more likely than DSH (31.3%) encounters to receive follow-up mental care. CONCLUSIONS: Although most older adults treated in EDs for suicide-related reasons are hospitalized, a substantial proportion of patients discharged back to the community do not receive follow-up mental healthcare within 30 days.
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