Recent medical service utilization and health conditions associated with a history of suicide attempts

Abstract

Objectives Suicide is a leading cause of death; unfortunately most individuals at risk for suicide are not identified, assessed or treated by the mental health system. Investigating medical healthcare utilization among individuals with a history of suicide attempt may identify alternative settings for case finding and brief intervention. Methods The study sample (n = 1422, 58% female, 72% African-American) is from a prospective cohort of adults (27-31 years) who participated in a randomized trial of school-based interventions. Logistic regression evaluated the relationship between lifetime history of suicide attempt with past year medical service utilization and selected self- reported health conditions, controlling for lifetime Major Depressive Disorder (MDD), demographic factors, health insurance status and employment. Results A suicide attempt history was associated with past year ED medical visits [aOR 1.51, 95% CI 1.04-2.18, p = .03], but not primary care visits or inpatient hospitalization, when controlling for MDD and other covariates. Severe headaches and chronic gastrointestinal conditions were also associated with lifetime suicide attempt (aOR 1.50 95% CI 1.03-2.17 and aOR 1.67 95% CI 1.06-2.63, respectively). Conclusions Suicide prevention, including universal screening and brief intervention, is indicated in ED settings. Restricting screening to subgroups, such as those individuals presenting with depression, may miss at-risk individuals with somatic concerns.

Lesão autoprovocada em todos os ciclos da vida: perfil das vítimas em serviços de urgência e emergência de capitais do Brasil

“…It is important to highlight the relevant, strategic and precise role of emergency medical care for victims of self-harm because these services: (1) constitute a gateway to health care and are the only option for a large part of the population in search of care; (2) they are appropriate in the epidemiological approach to the phenomenon; (3) they respond to suicide attempts, which are the strongest predictor of suicide in children, adolescents, adults and the elderly; and (4) they are often responsible for the immediate treatment of cases or referral to other services within the health system 29 . The emergency medical services have a potentially important role to play in detecting and caring for cases in the early stages of potential suicide, and they can help to prevent more serious harm to possible victims.…”

“…Ballard et al 29 recommend that all patients who are attended by emergency medical services, and who appear to have an association with selfharm, should be screened for the risk of committing suicide. In cases such as these, speedy intervention, together with the design of a safety plan that puts the patient in contact with mental health services, is one of the most beneficial and effective actions 1,34,35 .…”

Probabilidades de internação psiquiátrica de pacientes de um ambulatório de saúde mental

“…Importante salientar que os achados deste trabalho divergem de outros observados no âmbito internacional como, por exemplo, em um desses trabalhos, no qual os autores correlacionam utilizações dos serviços de saúde com condições de saúde, além dos resultados expostos, menciona--se sobre como é ampla a produção literária no sentido de afirmar que a depressão está associada ao aumento da utilização de serviços de nível terciário (26) . Os resultados obtidos nesse estudo, no que se refere à depressão, muito provavelmente, estão relacionados a alguma particularidade do serviço de saúde investigado, o que poderia motivar outros estudos no mesmo local, com a finalidade de entender tais particularidades.…”

“…Ainda que a probabilidade de internação dos pacientes acometidos por depressão possa ser considerada baixa, quando comparada, por exemplo, ao TAB e à esquizofrenia (Figura 4), deve haver especial atenção da equipe de saúde a essa clientela, especialmente a clientela mais idosa. A depressão está entre as doenças crônicas que mais atingem essa população e depreciam sua qualidade de vida (27) , além disso, o transtorno depressivo constitui fator de risco significativo para o suicídio, principalmente em indivíduos que necessitaram de atenção em nível hospitalar (26) .…”

“Let our Apache Heritage and Culture Live on Forever and Teach the Young Ones”: Development of The Elders’ Resilience Curriculum, an Upstream Suicide Prevention Approach for American Indian Youth

“…Culture has been used in the literature as a broad term that can refer to cultural identity/enculturation, or related variables like community connectedness or cultural spirituality. WMAT has long strived to understand the relationship between suicide and substance use in their community resulting in a line of research examining each risk separately and in combination (Ballard et al., , ; Barlow et al., ; Cwik et al., , , ; Tingey, Cwik, Chambers et al., in press; Tingey et al., , ; Tingey, Cwik, Rosenstock et al., ). A case–control study of risk factors for youth who had engaged in heavy binge drinking yielded the most detailed understanding of culture as prevention in this community.…”