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Cited by 65Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbuseMental Health Treatment and Access

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

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Fontanella, Cynthia A., Warner, Lynn A., Steelesmith, Danielle, Bridge, Jeffrey A., Sweeney, Helen Anne, Campo, John V.·2020·JAMA Pediatrics
DOI 10.1001/jamapediatrics.2020.0002PMC PMC7091475
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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. 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.

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  • Most young people who die by suicide visit a healthcare provider months, sometimes weeks, before their death.

    “Given that most young people who die by suicide visit a healthcare provider months, sometimes weeks, before their death, pediatric healthcare providers can use screening to begin important conversations about suicide risk via brief, evidence based screening tools.”

    From Suicide in young people: screening, risk assessment, and intervention (2023) · cites this paper as [56]

    The Discussion reports that 75% of Medicaid-enrolled youths who died by suicide used health care services in the six months before death, and 44.8% did so in the final month. This supports visits months—and sometimes weeks—before death, but the study's Medicaid-enrolled population does not establish the claim for young people generally. (LLM, conf=0.85)

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  • Up to 50% of all young people who die by suicide are seen in the emergency department or psychiatric inpatient setting in the year before death.

    “Up to 50% of all young people who die by suicide are seen in the emergency department or psychiatric inpatient setting in the year before death.”

    From Suicide in young people: screening, risk assessment, and intervention (2023) · cites this paper as [56]

    The Results and Discussion report emergency-department and inpatient visits among Medicaid-enrolled youths who died by suicide, and the Discussion says 21.1% had their final visit in an emergency department. The study examines visits in the 1 and 6 months before death, not the preceding year; it does not establish that up to 50% of all youths who die by suicide visited an emergency department or psychiatric inpatient setting in that year. Page numbers are unavailable in our copy. (LLM, conf=0.87)

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Authors
Fontanella, C. A., Warner, L. A., Steelesmith, D., Bridge, J. A., Sweeney, H. A., & Campo, J. V.
Affiliations
  • The Ohio State University Wexner Medical Center (US)
  • The Ohio State University (US)
  • Nationwide Children's Hospital (US)
  • Ohio Department of Mental Health & Addiction Services (US)
  • West Virginia University (US)
Corresponding author
Fontanella, Cynthia A.
ORCID
Venue
JAMA Pediatrics
Publisher
American Medical Association (AMA)
Published
2020-05-01
Volume
174
Issue
5
Pages
470
ISSN
  • 1072-4710 (ISSN-L)
  • 2168-6203
DOI
10.1001/jamapediatrics.2020.0002
PMC
PMC7091475
OpenAlex
W3012951471
Semantic Scholar
2f8d156795d7db21b97b24a7eb7a7dae465c4ffc
Cited by
65
References
38
Citations by year
2026: 11 · 2025: 13 · 2024: 9 · 2023: 6 · 2022: 10 · 2021: 12 · 2020: 4
FWCI
3.20
Type
journal article
Language
en
Open access
Locations
  • Archives of Pediatrics and Adolescent Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • American Foundation for Suicide Prevention
  • National Institute of Mental Health
  • National Institute of General Medical Sciences (U54GM104942)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
youth suicide, Medicaid, mental health service utilization, health care utilization, clinical profile, epilepsy, depression, schizophrenia, substance use disorders, suicide risk factors, suicide prevention, adolescents, children, behavioral health services
MeSH terms
Adolescent, Bipolar Disorder, Depression, Epilepsy, Female, Humans, Male, Medicaid, Mental Health Services, Risk Factors, Schizophrenic Psychology, Suicide, United States, Case-Control Studies, Substance-Related Disorders

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