Cynthia A Fontanella1, Lynn A Warner2, Danielle Steelesmith1, Jeffrey A Bridge3, Helen Anne Sweeney4, John V Campo5. 1. Department of Psychiatry and Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus. 2. Department of Psychiatry, The Ohio State University College of Medicine, Columbus. 3. Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio. 4. Ohio Department of Mental Health and Addiction Services, Columbus. 5. Rockefeller Neuroscience Institute, Behavioral Medicine and Psychiatry, West Virginia University, Morgantown.
Abstract
Importance: Youth suicide is a major public health problem, and health care settings play a critical role in suicide prevention efforts, but limited data are available to date on health and mental health service use patterns before suicide. Objective: To compare the clinical profiles and patterns of use of health and mental health care services among children and adolescents who died by suicide and a matched living control group. Design, Setting, and Participants: This population-based case-control study used Medicaid data from 16 states merged with mortality data. Suicide cases (n = 910) included all youths aged 10 to 18 years who died by suicide from January 1, 2009, to December 31, 2013. Controls (n = 6346) were matched to suicide cases on sex, race, ethnicity, Medicaid eligibility category, state, and age. Data were analyzed from July 18 to November 19, 2019. Exposures: Use of health and mental health care services. Main Outcomes and Measures: Health and behavioral health care visits in the 6-month period before the index date (date of suicide). Associations among visits, clinical characteristics, and suicide were examined using logistic regression. Results: The study population of 7256 Medicaid-enrolled youths included 5292 males (72.9%) with a mean (SD) age of 15.7 (2.0) years at the index date; 3619 (49.9%) were non-Hispanic white. Three hundred seventy-six suicide decedents (41.3%) had a mental health diagnosis in the 6 months before death compared with 1111 controls (17.5%; P < .001). A greater proportion of suicide decedents than controls used services before the index date (in 6 months, 687 suicide decedents [75.5%] vs 3669 controls [57.8%]; odds ratio [OR], 2.39 [95% CI, 2.02-2.82]). Suicide risk was highest among youths with epilepsy (OR, 4.89; 95% CI, 2.81-8.48; P < .001), depression (OR, 3.19; 95% CI, 2.49-4.09; P < .001), schizophrenia (OR, 3.18; 95% CI, 2.00-5.06; P < .001), substance use disorder (OR, 2.65; 95% CI, 1.67-4.20; P < .001), and bipolar disorder (OR, 2.09; 95% CI, 1.58-2.76; P < .001). More mental health visits within the 30 days before the index date were associated with decreased odds of suicide (OR, 0.78; 95% CI, 0.65-0.92; P = .005). Conclusions and Relevance: This study found that among youths aged 10 to 18 years who were enrolled in Medicaid, clinical characteristics and patterns of use of health care services among suicide decedents were distinct from those of nonsuicide controls. Implementation of suicide screening protocols for youths enrolled in Medicaid, targeted based on the frequency of visits, psychiatric diagnoses, and epilepsy, may have the potential to decrease suicide rates.
Importance: Youth suicide is a major public health problem, and health care settings play a critical role in suicide prevention efforts, but limited data are available to date on health and mental health service use patterns before suicide. Objective: To compare the clinical profiles and patterns of use of health and mental health care services among children and adolescents who died by suicide and a matched living control group. Design, Setting, and Participants: This population-based case-control study used Medicaid data from 16 states merged with mortality data. Suicide cases (n = 910) included all youths aged 10 to 18 years who died by suicide from January 1, 2009, to December 31, 2013. Controls (n = 6346) were matched to suicide cases on sex, race, ethnicity, Medicaid eligibility category, state, and age. Data were analyzed from July 18 to November 19, 2019. Exposures: Use of health and mental health care services. Main Outcomes and Measures: Health and behavioral health care visits in the 6-month period before the index date (date of suicide). Associations among visits, clinical characteristics, and suicide were examined using logistic regression. Results: The study population of 7256 Medicaid-enrolled youths included 5292 males (72.9%) with a mean (SD) age of 15.7 (2.0) years at the index date; 3619 (49.9%) were non-Hispanic white. Three hundred seventy-six suicide decedents (41.3%) had a mental health diagnosis in the 6 months before death compared with 1111 controls (17.5%; P < .001). A greater proportion of suicide decedents than controls used services before the index date (in 6 months, 687 suicide decedents [75.5%] vs 3669 controls [57.8%]; odds ratio [OR], 2.39 [95% CI, 2.02-2.82]). Suicide risk was highest among youths with epilepsy (OR, 4.89; 95% CI, 2.81-8.48; P < .001), depression (OR, 3.19; 95% CI, 2.49-4.09; P < .001), schizophrenia (OR, 3.18; 95% CI, 2.00-5.06; P < .001), substance use disorder (OR, 2.65; 95% CI, 1.67-4.20; P < .001), and bipolar disorder (OR, 2.09; 95% CI, 1.58-2.76; P < .001). More mental health visits within the 30 days before the index date were associated with decreased odds of suicide (OR, 0.78; 95% CI, 0.65-0.92; P = .005). Conclusions and Relevance: This study found that among youths aged 10 to 18 years who were enrolled in Medicaid, clinical characteristics and patterns of use of health care services among suicide decedents were distinct from those of nonsuicide controls. Implementation of suicide screening protocols for youths enrolled in Medicaid, targeted based on the frequency of visits, psychiatric diagnoses, and epilepsy, may have the potential to decrease suicide rates.
Authors: Hsueh-Han Yeh; Joslyn Westphal; Yong Hu; Edward L Peterson; L Keoki Williams; Deepak Prabhakar; Cathrine Frank; Kirsti Autio; Farah Elsiss; Gregory E Simon; Arne Beck; Frances L Lynch; Rebecca C Rossom; Christine Y Lu; Ashli A Owen-Smith; Beth E Waitzfelder; Brian K Ahmedani Journal: Psychiatr Serv Date: 2019-06-12 Impact factor: 3.084
Authors: Mark A Ilgen; Kenneth R Conner; Kathryn M Roeder; Frederic C Blow; Karen Austin; Marcia Valenstein Journal: Am J Public Health Date: 2012-01-25 Impact factor: 9.308
Authors: Barbara Stanley; Gregory K Brown; Lisa A Brenner; Hanga C Galfalvy; Glenn W Currier; Kerry L Knox; Sadia R Chaudhury; Ashley L Bush; Kelly L Green Journal: JAMA Psychiatry Date: 2018-09-01 Impact factor: 21.596
Authors: Maurizio Pompili; Xavier F Amador; Paolo Girardi; Jill Harkavy-Friedman; Martin Harrow; Kalman Kaplan; Michael Krausz; David Lester; Herbert Y Meltzer; Jiri Modestin; Lori P Montross; Preben Bo Mortensen; Povl Munk-Jørgensen; Jimmi Nielsen; Merete Nordentoft; Pirjo Irmeli Saarinen; Sidney Zisook; Scott T Wilson; Roberto Tatarelli Journal: Ann Gen Psychiatry Date: 2007-03-16 Impact factor: 3.455
Authors: Nicholas Abraham; P Buvanaswari; Rahul Rathakrishnan; Bach X Tran; Giang Vu Thu; Long H Nguyen; Cyrus S Ho; Roger C Ho Journal: Int J Environ Res Public Health Date: 2019-04-24 Impact factor: 3.390
Authors: Paige E Cervantes; Annie Li; Katherine A Sullivan; Dana E M Seag; Argelinda Baroni; Sarah M Horwitz Journal: J Autism Dev Disord Date: 2022-02-04
Authors: Kenneth W McKinley; Kelly N Z Rickard; Finza Latif; Theresa Wavra; Julie Berg; Sephora Morrison; James M Chamberlain; Shilpa J Patel Journal: Healthc Inform Res Date: 2022-01-31
Authors: Paige E Cervantes; Dana E M Seag; Argelinda Baroni; Ruth Gerson; Katrina Knapp; Ee Tein Tay; Ethan Wiener; Sarah McCue Horwitz Journal: Psychiatr Serv Date: 2021-06-09 Impact factor: 3.084