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Cited by 146Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbuseOpioid Use Disorder Treatment

Variation in patterns of health care before suicide: a population case-control study.

Open access
Ahmedani, Brian K., Westphal, Joslyn, Autio, Kirsti, Elsiss, Farah, Peterson, Edward L., Beck, Arne, Waitzfelder, Beth E., Rossom, Rebecca C. +12 more·2019·Preventive Medicine
DOI 10.1016/j.ypmed.2019.105796PMC PMC6744956
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Abstract

Background: The United States has experienced a significant rise in suicide. As decision makers identify how to address this national concern, healthcare systems have been identified as an optimal location for prevention. Objective: To compare variation in patterns of healthcare use, by health setting, between individuals who died by suicide and the general population. Design: Case-Control Study. Setting: Eight healthcare systems across the United States. Participants: 2,674 individuals who died by suicide between 2000–2013 along with 267,400 individuals matched on time-period of health plan membership and health system affiliation. Measurements: Healthcare use in the emergency room, inpatient hospital, primary care, and outpatient specialty setting measured using electronic health record data during the 7-, 30-, 60-, 90-, 180-, and 365-day time periods before suicide and matched index date for controls. Results: Healthcare use was more common across all healthcare settings for individuals who died by suicide. Nearly 30% of individuals had a healthcare visit in the 7-days before suicide (6.5% emergency, 16.3% outpatient specialty, and 9.5% primary care), over half within 30 days, and >90% within 365 days. Those who died by suicide averaged 16.7 healthcare visits during the year. The relative risk of suicide was greatest for individuals who received care in the inpatient setting (aOR=6.23). There was both a large relative risk (aOR=3.08) and absolute utilization rate (43.8%) in the emergency room before suicide. Limitations: Participant race/ethnicity was not available. The sample did not include uninsured individuals. Conclusions: This study provides important data about how care utilization differs for those who die by suicide compared to the general population and can inform decision makers on targeting of suicide prevention activities within health systems.

Integrity signals

Registry

Crossref · 10.1016/j.ypmed.2019.105796

Cites

46 of 46 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 24 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Compared with matched general population controls, people who die by suicide are much more likely to make an emergency room visit, including a substantial difference shortly before suicide.

    “Compared to matched general population controls, those who die by suicide are much more likely to make an emergency room visit (including a substantial difference right before suicide).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.
  • Findingown data

    Visits with recorded mental health and substance use diagnoses showed the largest variation in relative suicide risk between cases and controls.

    “In this study, visits with recorded mental health and substance use diagnoses represented the largest variation in relative risk of suicide between cases and controls.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.
  • Findingown data

    The setting with the highest relative odds (inpatient) had the lowest absolute utilization rate.

    “Alternatively, the setting with the greatest relative odds (inpatient), also had the smallest absolute utilization rate.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.
  • Findingown data

    A larger proportion of cases and controls with Medicare/Medicaid visited each setting than those with commercial or 'other' insurance.

    “However, a greater proportion of cases and controls with Medicare/Medicaid made healthcare visits in each setting as compared with those who had commercial or ‘other’ health insurance products.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.
  • Findingown data

    More than 90% of cases and 80% of controls made visits in the year before the index date across all insurance types.

    “Over 90% of cases and 80% of controls made visits within the year prior to the index date for all insurance types.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.
  • May combine two claims. 34
  • Classified as probably not a substantial claim. 23

  • May combine two claims.

    Findingown data

    In the inpatient setting, 5.9% of cases versus 0.2% of controls were hospitalized within 7 days, and nearly 29% of cases versus 6% of controls within 365 days.

    “This wide variation also extended to the inpatient setting where 5.9% of cases versus 0.2% of controls were hospitalized in the 7-day period and nearly 29% of cases compared with 6% of controls were hospitalized within the 365-day period.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • May combine two claims.

    Findingown data

    Smaller differences remain between people at risk for suicide and the general population in primary care and outpatient medical specialty use, but these are the most common visit types before suicide.

    “There remain smaller differences between individuals at risk for suicide and the general population in use of primary care and outpatient medical specialty care, but these represent the most common visit types before suicide.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • May combine two claims.

    Findingown data

    Emergency room or inpatient visits with a recorded mental health or substance use disorder had the highest suicide risk, with adjusted odds ratios above 60.0 in the 7-day period and above 10.0 for each visit type in the 365-day period.

    “While a smaller proportion of the sample had emergency room or inpatient hospitalization with a mental health or substance use disorder recorded, these visit types had the greatest risk of suicide with the adjusted odds ratio >60.0 during the 7-day period and >10.0 for each visit type during the 365-day period.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • May combine two claims.

    Findingown data

    In the 365-day period, more than 91% of cases and more than 85% of controls had at least one healthcare encounter.

    “During the 365-day period, most study individuals had a healthcare encounter, including >91% of cases and >85% of controls.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • May combine two claims.

    Findingown data

    Among controls, fewer than 15% had a mental health visit and about 5% had a substance use visit in the same period.

    “Among controls, fewer than 15% had a mental health visit and approximately 5% had a substance use visit during the same time-period.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • May combine two claims.

    Findingown data

    About half of cases had a mental health diagnosis visit and 28% had a substance use diagnosis visit within 365 days.

    “Overall, approximately half of those who died by suicide had a visit with a mental health diagnosis whereas 28% of cases had a visit with a substance use diagnosis recorded within the 365-day period.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • May combine two claims.

    Findingown data

    Primary care and outpatient medical specialty were the most common visit types over 365 days; about 79% of cases had each type, compared with 73% of controls for primary care and 63% for medical specialty.

    “Primary care and outpatient medical specialty visits were the most common visit types during the 365-day period for all individuals; however, individuals who died by suicide (~79% for each subtype) made each of those visit types more than controls (73% in primary care and 63% in medical specialty settings).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • May combine two claims.

    Findingown data

    On average, people who die by suicide have nearly 10 outpatient medical specialty visits and 4 primary care visits in the year before death, significantly more than controls.

    “As a result, there are many opportunities for identification and early treatment, as on average, individuals who die by suicide have nearly 10 outpatient medical specialty and 4 primary care visits in the year before death -significantly more than controls.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • May combine two claims.

    Findingown data

    Most individuals make healthcare visits before suicide, and visit patterns for those who died by suicide differ from the general population.

    “This study found that most individuals make healthcare visits before suicide and visit patterns for those who died by suicide differ from the general population.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • May combine two claims.

    Findingown data

    About 21% of controls had an emergency room visit in the year before the index date, and only 0.6% within 7 days.

    “This is in contrast with approximately 21% of controls with emergency room visits within the year before the index date and only 0.6% with 7-days.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • May combine two claims.

    Findingown data

    In the emergency room, nearly 7% of cases visited within 7 days, more than 14% within 30 days, and 43.8% within 365 days before suicide.

    “In the emergency room, nearly 7% of cases made a visit within 7-days, >14% within 30 days, and nearly half (43.8%) within 365 days before suicide.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • May combine two claims.

    Findingnone given

    Inpatient hospitalizations are much more common among people who die by suicide than the general population, but only a small number received this care.

    “Inpatient hospitalizations are also much more common for individuals who die by suicide as compared to the general population, but overall, a small number of people received this type of care.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • May combine two claims.

    Findingown data

    Cases averaged nearly 5 mental health visits and 2 substance use visits, compared with less than 1 of each for controls.

    “On average, cases had nearly 5 visits with a mental health diagnosis and 2 visits with a substance use diagnosis as compared to less than 1 visit each for controls.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • May combine two claims.

    Findingown data

    About one-third of cases had any healthcare visit in the 7 days before suicide, compared with about 11% of controls.

    “Nearly one-third of cases made any type of visit during the 7-day period prior to suicide as compared with approximately 11 % of controls.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • May combine two claims.

    Findingown data

    Across insurance types, 53-55% of cases had a mental health diagnosis visit, while about 30% of those with commercial or other insurance and 21% of those with Medicare/Medicaid had a substance use diagnosis visit.

    “Across all insurance types, between 53–55% of cases had a visit with a mental health diagnosis, while ~30% of those with commercial or other insurance versus 21% of those with Medicare/Medicaid had a visit with a substance use diagnosis.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • May combine two claims.

    Findingown data

    Both groups made most visits in outpatient medical specialty (9.9 for cases vs 4.1 for controls) and primary care (3.8 vs 2.4).

    “Both sample groups made most visits in outpatient medical specialty (9.9 visits for cases versus 4.1 visits for controls) and primary care settings (3.8 visits for cases versus 2.4 visits for controls).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • May combine two claims.

    Findingown data

    For people with 'other' insurance, healthcare use was more common among cases than controls for every visit type except primary care, where no difference was observed.

    “This remained consistent for individuals with ‘other’ types of health insurance, except for primary care visits where there were no observed differences between cases and controls.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The CDC reported that roughly half of individuals have a known mental health condition before suicide, and under 40% received behavioral health treatment beforehand.

    “The report indicated that approximately half of people have a known mental health condition before suicide, and fewer than 40% have received behavioral health treatment prior to suicide.1”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Stone DM, Simon TR, Fowler KA, Vital Signs: Trends in State Suicide Rates - United States, 1999–2016 and Circumstances Contributing to Suicide −27 States, 2015. Morb Mortal Wkly Rep. 2018; 67(22): 617– 624. PMC5991813 29879094 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    More than 80% of people visit a healthcare provider in the year before suicide or a suicide attempt, but most of those visits are in general medical settings and lack a recorded mental health or substance use disorder diagnosis.

    “These data are consistent with other studies, which have found that >80% of individuals make a healthcare visit in the year before suicide or suicide attempt, though most visits occur in general medical settings and do not include a recorded mental health or substance use disorder diagnosis.11–14”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [11] Ahmedani BK, Simon GE, Stewart C, Health care contacts in the year before suicide death. Journal of General Internal Medicine. 2014; 29(6): 870– 877 PMC4026491 24567199 source

      Not checked in the free run.

    • cites [12] Renaud J, Berlim MT, Seguin M, McGirr A, Tousignant M, Turecki G. Recent and lifetime utilization of health care services by children and adolescent suicide victims: a case-control study. Journal of affective disorders. 2009; 117(3): 168– 173 19187970 source

      Not checked in the free run.

    • cites [13] Luoma JB, Martin CE, Pearson JL. Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry. 2002; 159(6): 909– 916 12042175 PMC5072576 source

      Not checked in the free run.

    • cites [14] Ahmedani BK, Stewart C, Simon GE, Racial/Ethnic differences in health care visits made before suicide attempt across the United States. Med Care. 2015; 53(5): 430– 435.4397662 25872151 PMC4397662 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The data do not provide information on the adequacy or patient satisfaction of services or on level of care satisfaction.

    “Also, these data do not provide information on the adequacy or patient satisfaction of services or the level of care satisfaction.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The participating health systems did not cover all US states.

    “The current study included a large sample of individuals in geographically diverse US regions, but the participating health systems did not cover all US states.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Because of limitations in historical data capture, the study did not ascertain race/ethnicity records.

    “Due to limitations in historical data capture, this study also did not ascertain race/ethnicity records.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    The findings may not generalize to uninsured individuals, some of whom may be at high risk.

    “Furthermore, these findings may not generalize to individuals who are uninsured, some of whom may be at high risk.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Education and income levels did not differ significantly between groups and were not used as adjustment variables.

    “Education and income levels were not significantly different between study groups and were not used for adjustment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The Virtual Data Warehouse data undergo regular quality control checks.

    “These data are regularly subject to quality control verification.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Cases were more often male (77.5% vs 47.5%) and older (mean 49.9 vs 39.4 years) than controls.

    “cases were more likely to be men (77.5% male versus 47.5% for controls) and older aged (mean 49.9 years old versus 39.4 years old for controls).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The study indicates there are unique opportunities to prevent suicide in all healthcare system settings.

    “Our study suggests that there are unique opportunities to prevent suicide in all health system settings.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Eligible suicide deaths from 2000-2013 were identified from VDW mortality records using ICD-10 codes X60-X84 and Y87.0.

    “For this study, eligible individuals who died by suicide from 2000–2013 were i0064entified from VDW mortality records using International Classification of Diseases, 10th revision (ICD-10) codes ranging from X60-X84 and Y87.0.27”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] WHO. International Classification of Diseases, Tenth Revision. http://www.whoint/classifications/icd/en/ 2012.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study could not separate Medicaid from Medicare insurance types.

    “Finally, we were not able to separate Medicaid versus Medicare insurance types.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Studies have found that a higher total number of visits is associated with suicide.

    “Studies have found that a greater number of overall visits were associated with suicide.18,19”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [18] Morrison KB, Laing L. Adults’ use of health services in the year before death by suicide in Alberta. Health Rep. 2011; 22(3): 15– 22 22106785

      Not checked in the free run.

    • cites [19] Windfuhr K, While D, Kapur N, Suicide risk linked with clinical consultation frequency, psychiatric diagnoses and psychotropic medication prescribing in a national study of primary-care patients. Psychol Med. 2016; 46(16): 3407– 3417 27650367 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The study supports prior research showing that nearly all people who die by suicide make a healthcare visit in the year before death and about half contact the health system within a month of suicide.

    “This study also supports prior research demonstrating that nearly all individuals who die by suicide make a healthcare visit in the year before death and approximately half make contact with the health system within a month of suicide.11,13”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [11] Ahmedani BK, Simon GE, Stewart C, Health care contacts in the year before suicide death. Journal of General Internal Medicine. 2014; 29(6): 870– 877 PMC4026491 24567199 source

      Not checked in the free run.

    • cites [13] Luoma JB, Martin CE, Pearson JL. Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry. 2002; 159(6): 909– 916 12042175 PMC5072576 source

      Not checked in the free run.

    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The study did not match on age or gender because the analysis is part of a larger project intended to conduct subgroup analyses.

    “Study procedures did not include matching for age or gender, because this analysis is part of a larger study which seeks to conduct sub-group analyses.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    All models were conditional on site, and adjusted models also controlled for age and sex.

    “All models were conditional on site, and adjusted models also controlled for age and sex, consistent with other studies.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Electronic health records were linked to official state mortality records, including date and cause of death, using Social Security numbers or a combination of names, birthdates, and demographic profiles following the CDC scheme.

    “Electronic records were matched to official state government mortality records, including date and cause of death, using Social Security numbers or a combination of patient names, birthdates, and demographic profiles consistent with the CDC scheme.25,26”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [25] Boggs JM, Simon GE, Ahmedani BK, Peterson E, Hubley S, Beck A. The Association of Firearm Suicide With Mental Illness, Substance Use Conditions, and Previous Suicide Attempts. Ann Intern Med. 2017; 167(4): 287– 288. 28672343 PMC5555812 source

      Not checked in the free run.

    • cites [26] CDC. ICD framework: External cause of injury mortality matrix. http://www.cdc.gov/nchs/injury/ice/matrix10.htm 2010.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Race and ethnicity data were unavailable before 2008, so they were not included.

    “Race and ethnicity data were not available prior to 2008, thus these data were not included.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The risk signal is large for all emergency visits, not only those with a mental health diagnosis.

    “While it is not unique that individuals seen in the emergency room with a mental health diagnosis are at risk, it is important to note that the risk signal for all emergency visits is also large.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The study supports recent policy and system-level initiatives suggesting unique opportunities to prevent suicide in all healthcare settings.

    “This study supports recent policy and system-level initiatives suggesting that there are unique opportunities to prevent suicide in all healthcare settings.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A US study found no difference between suicide decedents and general population controls in whether they made any healthcare visit, but suicide decedents made more visits overall.

    “One US study found no difference in whether or not suicide decedents or general population controls made a healthcare visit, but did find that suicide decedents made more visits overall.16”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Chock MM, Bommersbach TJ, Geske JL, Bostwick JM. Patterns of Health Care Usage in the Year Before Suicide: A Population-Based Case-Control Study. Mayo Clin Proc. 2015; 90(11): 1475– 1481. 26455886 PMC4999076 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Research outside the US indicates emergency room visits may be twice as frequent among people who die by suicide, and a rising count of emergency room visits is an independent risk factor.

    “Evidence from outside the US has shown that emergency room visits may occur twice as often for individuals who die by suicide, and that an increasing number of emergency room visits is an independent risk factor.17”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Kvaran RB, Gunnarsdottir OS, Kristbjornsdottir A, Valdimarsdottir UA, Rafnsson V. Number of visits to the emergency department and risk of suicide: a population-based case-control study. bMc Public Health. 2015; 15: 227. 25884880 PMC4361138 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The emergency room provides a unique prevention opportunity because a large proportion of patients receive care there before suicide and the relative risk difference is substantial.

    “The emergency room provides a unique opportunity for prevention given that a large proportion of patients receive care in that setting before suicide, and the relative risk difference is substantial.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.

  • Classified as probably not a substantial claim.

    Premisereasoning

    Existing studies give conflicting evidence about whether people who die by suicide are more likely to use various types of health services than the general population.

    “These studies provide conflicting information on whether those who die by suicide are more likely to have various types of health service use as compared to the general population.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    Most prior studies were conducted outside the US in different health system models, and US studies were limited by small samples in single geographic areas.

    “To date, most studies have been conducted outside of the US within different health system models, and studies from the US have been restricted by smaller sample sizes in singular geographic regions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The mortality status of controls is unknown, but most were likely alive past the index date because they were enrolled.

    “We do not know the mortality status of controls, but most were likely living past the index date since they were enrolled.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Controls were alive at the index date.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Statistical significance was tested with two-tailed tests and Hochberg's method for multiple comparisons, using an adjusted threshold of p=0.05.

    “Statistical significance was assessed via two-tailed tests using Hochberg’s method for multiple comparison adjustments with an adjusted threshold of p=0.05.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationown data

    The findings support the Joint Commission's Sentinel Event Alert #56 recommendation to identify and treat suicide risk in all healthcare settings.

    “The Joint Commission’s Sentinel Event Alert #56 is supported by the findings from this study by recommending identification approaches and treatment for suicide risk in all healthcare settings.10”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Commission TJ. Sentinel Event Alert 56: Detecting and treating suicide ideation in all settings. http://www.jointcommission.org/sea_issue_56/, 2016. 26915165

      Not checked in the free run.

    • Rests on an assumption: The control group of health plan members is representative of the general population for comparing healthcare utilization.
45 of 45

  • The paper relies on this without support.

    The control group of health plan members is representative of the general population for comparing healthcare utilization.

    “we randomly selected a sample of 100 control individuals per case for a total of 267,400 general population control individuals.”

  • The paper relies on this without support.

    Individuals who died by suicide identified from VDW mortality records are representative of all suicide deaths in the participating health systems.

    “A total of 2,674 individuals who died by suicide (cases) from 2000–2013, were members of the participating systems and were continuously enrolled in the health plan for at least 10 months during the year prior to their death, were included.”

  • The paper relies on this without support.

    Controls were alive at the index date.

    “We do not know the mortality status of controls, but most were likely living past the index date since they were enrolled.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. US Department of Health and Human Services, 2012, vol. 2012

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Related

Authors
Ahmedani, B. K., Westphal, J., Autio, K., Elsiss, F., Peterson, E. L., Beck, A., Waitzfelder, B. E., Rossom, R. C., Owen-Smith, A. A., Lynch, F., Lu, C. Y., Frank, C., Prabhakar, D., Braciszewski, J. M., Miller-Matero, L. R., Yeh, H.-H., Hu, Y., Doshi, R., Waring, S. C., & Simon, G. E.
Affiliations
  • Henry Ford Health (US)
  • Kaiser Permanente (US)
  • HealthPartners (US)
  • Harvard University (US)
  • UConn Health (US)
  • Essentia Health (US)
  • Kaiser Permanente Washington Health Research Institute (US)
Corresponding author
Ahmedani, Brian K.
ORCID
Venue
Preventive Medicine
Publisher
Elsevier BV
Published
2019-10
Volume
127
Pages
105796
ISSN
0091-7435 (ISSN-L)
DOI
10.1016/j.ypmed.2019.105796
PMC
PMC6744956
OpenAlex
W2965207362
Semantic Scholar
6a8b17b7c614c4fca2fb5b814206113ed9d34842
Cited by
146
References
46
Citations by year
2026: 26 · 2025: 29 · 2024: 23 · 2023: 19 · 2022: 24 · 2021: 16 · 2020: 9
FWCI
14.30
Type
journal article
Language
en
Open access
Licence
Locations
  • Preventive Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords
suicide, health care utilization, emergency department visits, inpatient care, primary care, healthcare settings, suicide prevention, health care system
MeSH terms
Adult, Emergency Service, Hospital, Female, Humans, Inpatients, Male, Mental Health Services, Middle Aged, Outpatients, Patient Acceptance of Health Care, Primary Health Care, Risk Factors, Suicide, Time Factors, United States, Case-Control Studies

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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