Clinical Profiles and Health Services Patterns of Medicaid-Enrolled Youths Who Died by Suicide

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. RESULTSThe 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.

Health Services Use by Children in the Welfare System Who Died by Suicide

“…These results are consistent with a study of Medicaidenrolled youth revealing that 45% and 76% of suicide decedents accessed health care services in the 1 and 6 months before death, respectively. 41 Suicide decedents were twice as likely to access mental health services within both time periods compared with nondecedents, which may be related to the higher percentage of suicide decedents diagnosed with a mental health condition. Youth in the child welfare system who died by suicide were also more likely to have received mental health-related inpatient and emergency department services.…”

Recognizing the importance of childhood maltreatment as a critical factor in psychiatric diagnoses, treatment, research, prevention, and education

“…The absence of required specifiers for CM in the current formulation of the DSM distorts and impairs the value of many contemporary studies on the neurobiology, epidemiology, and treatment of psychiatric disorders. For example, a recently published [83], comprehensive analysis of risk factors for suicides in juveniles included over 7000 children and 910 suicides. Data were obtained from death certificates and Medicaid billing files.…”

Acetaminophen poisonings in Chilean healthcare settings: a 20-year story that does not end

“…Furthermore, patients admitted into healthcare settings because of intentional poisonings should receive immediate psychiatric attention, especially those who repeatedly present with suicide attempts. This way is easier to predict common patters among these types of individuals who have previously shown self-harm behavior [ 33 ]. Also, other intentional poisoning risk factors are associated with alcohol or illicit drug consumption, and psychological stressors (e.g.…”