Investigators from multiple institutions conducted a case-control study to compare clinical conditions and health care services among children 10–18 years old who died by suicide to those of living controls. Cases were children and adolescents from 16 US states who were enrolled in Medicaid and died by suicide between 2009 and 2013. Review of death certificates was used to identify these cases. Up to 10 controls were matched to each case on sex, race, ethnicity, state of residence, and age. Medicaid databases were reviewed, and information on all mental health (MH) and physical health (PH) visits in the 6-month period before the date of death (index date) were abstracted for cases and their matching controls. Visits were categorized as MH or PH visits using ICD-9 and/or mental health procedure codes. Conditional logistic regression was used to identify psychiatric conditions associated with death by suicide and to assess the impact of number of mental health visits within 30 days of the index date on the risk of suicide. Chi-square tests were used to compare numbers and types of visits in cases and controls.
Data were analyzed on 910 youths who died by suicide and 6,346 controls. Overall, 72.9% of the sample was male, and the mean age at the index date was 15.7 + 2.0 years. Among cases, 41.3% had a mental health diagnosis compared to 17.5% of controls (P < .001). In the 1 month before the index date, 22.4% of cases had an MH visit versus 10.1% of controls, and 32.1% had a PH visit versus 17.2% of controls (odds ratio [OR], 3.21; 95% CI, 2.65–3.89; and OR, 2.38; 95% CI, 2.03–2.79, respectively). In the final 6 months before the index date, cases were significantly more likely than controls to have an MH or PH visit than controls (40.3% and 66.3%, respectively, vs 18.8% and 52%, respectively). Among those with any visits, 24.5% of cases had ≥4 MH visits in the 1 month before the index case, compared to 18.3% of controls (P < .001), and 26.7% had ≥2 PH visits versus 19.0% of controls (P < .001). For every 5 MH visits in the month before the index date, the risk of suicide decreased (OR, 0.78; 95% CI, 0.65–0.92). Psychiatric conditions associated with a significantly increased risk for suicide included depression (OR, 3.19), bipolar or mood diagnosis (OR, 2.09), and substance use disorder (OR, 2.65).
The authors conclude that use of health care services among youths who die by suicide were distinct from those of living controls.
Dr Chung has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
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