Stephanie K Doupnik1, Molly Passarella2, Christian Terwiesch3, Steven C Marcus4. 1. Department of Pediatrics, Center for Pediatric Clinical Effectiveenss, and PolicyLab, Children's Hospital of Philadelphia (SK Doupnik and M Passarella), Philadelphia, Pa; The Leonard Davis Institute of Health Economics, The University of Pennsylvania (SK Doupnik, C Terwiesch, and SC Marcus), Philadelphia, Pa. Electronic address: DoupnikS@chop.edu. 2. Department of Pediatrics, Center for Pediatric Clinical Effectiveenss, and PolicyLab, Children's Hospital of Philadelphia (SK Doupnik and M Passarella), Philadelphia, Pa. 3. Wharton School (C Terwiesch), Philadelphia, Pa; The Leonard Davis Institute of Health Economics, The University of Pennsylvania (SK Doupnik, C Terwiesch, and SC Marcus), Philadelphia, Pa. 4. School of Social Policy and Practice and Center for Mental Health (SC Marcus), Philadelphia, Pa; The Leonard Davis Institute of Health Economics, The University of Pennsylvania (SK Doupnik, C Terwiesch, and SC Marcus), Philadelphia, Pa.
Abstract
INTRODUCTION: Mental health follow-up after an emergency department (ED) visit for suicide ideation/attempt is a critical component of suicide prevention for young people. METHODS: We analyzed 2009 to 2012 Medicaid Analytic EXtract for 62,139 treat-and-release ED visits and 30,312 ED-to-hospital admissions for suicide ideation/attempt among patients ages 6 to 17 years. We used mixed-effects logistic regression models to examine associations between patients' health care utilization prior to the ED visit and likelihood of completing a 30-day mental health follow-up visit. RESULTS: Overall, for treat-and-release ED visits, 49% had a 30-day follow-up mental health visit, and for ED-to-hospital admissions, 67% had a 30-day follow-up mental health visit. Having a mental health visit in the 30 days preceding the ED visit was the strongest predictor of completing a mental health follow-up visit (ED treat-and-release: adjusted odds ratio [AOR] 11.01; 95% confidence interval [CI] 9.82-12.35; ED-to-hospital AOR 4.60; 95% CI 3.16-6.68). Among those with no mental health visit in the 30 days preceding the ED visit, only 25% had an ambulatory mental health follow-up visit. Having a general health care visit in the 30 days preceding the ED visit had a much smaller association with completing a mental health follow-up visit (ED treat-and-release: AOR 1.17; 95% CI 1.09-1.24; ED-to-hospital AOR 1.25; 95% CI 1.17-1.34). CONCLUSIONS: Young people without an existing source of ambulatory mental health care have low rates of mental health follow-up after an ED visit for suicide ideation or attempt, and opportunities exist to improve mental health follow-up for youth with recent general health care visits.
INTRODUCTION: Mental health follow-up after an emergency department (ED) visit for suicide ideation/attempt is a critical component of suicide prevention for young people. METHODS: We analyzed 2009 to 2012 Medicaid Analytic EXtract for 62,139 treat-and-release ED visits and 30,312 ED-to-hospital admissions for suicide ideation/attempt among patients ages 6 to 17 years. We used mixed-effects logistic regression models to examine associations between patients' health care utilization prior to the ED visit and likelihood of completing a 30-day mental health follow-up visit. RESULTS: Overall, for treat-and-release ED visits, 49% had a 30-day follow-up mental health visit, and for ED-to-hospital admissions, 67% had a 30-day follow-up mental health visit. Having a mental health visit in the 30 days preceding the ED visit was the strongest predictor of completing a mental health follow-up visit (ED treat-and-release: adjusted odds ratio [AOR] 11.01; 95% confidence interval [CI] 9.82-12.35; ED-to-hospital AOR 4.60; 95% CI 3.16-6.68). Among those with no mental health visit in the 30 days preceding the ED visit, only 25% had an ambulatory mental health follow-up visit. Having a general health care visit in the 30 days preceding the ED visit had a much smaller association with completing a mental health follow-up visit (ED treat-and-release: AOR 1.17; 95% CI 1.09-1.24; ED-to-hospital AOR 1.25; 95% CI 1.17-1.34). CONCLUSIONS: Young people without an existing source of ambulatory mental health care have low rates of mental health follow-up after an ED visit for suicide ideation or attempt, and opportunities exist to improve mental health follow-up for youth with recent general health care visits.
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