Elsevier

Academic Pediatrics

Volume 15, Issue 1, January–February 2015, Pages 36-40
Academic Pediatrics

Mental Health of Children and Adolescents
Evaluation and Disposition of Medicaid-Insured Children and Adolescents With Suicide Attempts

https://doi.org/10.1016/j.acap.2014.04.005Get rights and content

Abstract

Objective

Guidelines and quality of care measures for the evaluation of adolescent suicidal behavior recommend prompt mental health evaluation, hospitalization of high-risk youth, and specific follow-up plans—all of which may be influenced by sociodemographic factors. The aim of this study was to identify sociodemographic characteristics associated with variations in the evaluation of youth with suicidal behavior.

Methods

We conducted a large cohort study of youth, aged 7 to 18, enrolled in Tennessee Medicaid from 1995 to 2006, who filled prescriptions for antidepressants and who presented for evaluation of injuries that were determined to be suicidal on the basis of external cause-of-injury codes (E codes) and ICD-9-CM codes and review of individual medical records. Chi-square tests and logistic regression were performed to assess the relationship between sociodemographic characteristics and documentation of mental health evaluation, hospitalization, and discharge instructions.

Results

Of 929 episodes of suicidal behavior evaluated in an acute setting, rural-residing youth were less likely to be admitted to a psychiatric hospital (adjusted odds ratio [AOR] 0.72; 95% confidence interval [CI] 0.55–0.95) and more likely to be medically hospitalized only (AOR 1.92; 95% CI 1.39–2.65). Female subjects were less likely to be admitted to a psychiatric hospital (AOR 0.55; 95% CI 0.41–0.74) and more likely to be discharged home (AOR 1.44; 95% CI 1.01–2.04). Only 40% of those discharged to home had documentation of discharge instructions with both follow-up provider and date.

Conclusions

In this statewide cohort of youth with suicidal behavior, there were significant differences in disposition associated with sociodemographic characteristics.

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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  • The authors declare that they have no conflict of interest.

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