Mental Health of Children and AdolescentsEvaluation and Disposition of Medicaid-Insured Children and Adolescents With Suicide Attempts
Section snippets
Methods
The study was performed as part of a larger retrospective cohort study of antidepressant use and suicidal behavior in children and adolescents that included 80,183 youth (aged 6 to 18 years) who were enrolled in Tennessee's Medicaid Program (TennCare) between 1995 and 2006 and who were prescribed an antidepressant medication.15 The methods for identifying and confirming suicidal behavior in this cohort have been previously described.16 Briefly, TennCare claims data and linked death certificates
Results
Of the 929 youth with confirmed suicidal events, 72% were girls, 82% were white, and 42% resided in a rural area. Fifty-six percent of the cohort was aged 15 to 18 years. Ingestion was the most common mechanism of injury, accounting for 81% of the suicidal episodes, and cutting was the second most common (9%). The presence of a psychiatric history was documented in 91% of the cases, and a previous suicide attempt was documented in 41% of the cases. Inconsistencies in clinical documentation of
Discussion
In this large statewide cohort study of Medicaid-insured adolescents who presented with suicidal behavior, we identified differences in the evaluation and disposition of youth that were associated with sociodemographic characteristics. Some of these differences can be attributed at least in part to the epidemiology of suicide risk. Other differences are more likely to reflect differences in available resources. We also identified potential missed opportunities for mental health evaluation and
Conclusions
In this statewide cohort of Medicaid-insured youth with confirmed suicidal behavior, those from rural residences were less likely to be hospitalized in a psychiatric facility and more likely to be medically hospitalized. Of youth discharged home after acute evaluation of suicidal behavior, less than half had documentation of a specific follow-up plan. With increasing focus on accountable care, these findings suggest barriers and opportunities to implementing evidence-based care for youth with
Acknowledgments
Funding was provided by the National Institute of Mental Health (grant 5R01MH079903-03, Suicidality Associated With Antidepressants in TennCare Children and Adolescents) to Dr Cooper. Presented in part at the 2013 annual meeting of the Pediatric Academic Societies, Washington, DC.
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2014, Journal of Preventive Medicine and Public Health
The authors declare that they have no conflict of interest.