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- Title
Clinical Profiles and Health Services Patterns of Medicaid-Enrolled Youths Who Died by Suicide.
- Authors
Fontanella, Cynthia A.; Warner, Lynn A.; Steelesmith, Danielle; Bridge, Jeffrey A.; Sweeney, Helen Anne; Campo, John V.
- Abstract
This population-based case-control study compares 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. Key Points: Question: What are the clinical profiles and mental health service patterns of children and adolescents who died by suicide, and how do they differ from those of the general population? Findings: This population-based case-control study found that suicide risk was highest among youths with epilepsy, depression, schizophrenia, substance use disorder, and bipolar disorder. Increased mental health visits within the 30 days before the index date were associated with decreased odds of suicide. Meaning: These findings suggest that implementation of suicide screening protocols for youths enrolled in Medicaid, targeted based on frequency of visits, psychiatric diagnoses, and epilepsy, has 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.
- Subjects
SUICIDE prevention; SUICIDE risk factors; CONFIDENCE intervals; HEALTH behavior; MEDICAID; MEDICAL care use; MEDICAL screening; MENTAL health services; RISK assessment; SUICIDE; LOGISTIC regression analysis; CASE-control method; ODDS ratio; ADOLESCENCE
- Publication
JAMA Pediatrics, 2020, Vol 174, Issue 5, p470
- ISSN
2168-6203
- Publication type
Article
- DOI
10.1001/jamapediatrics.2020.0002