https://orcid.org/0000-0002-2919-9493
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Abstract
Objective
Suicide is the second leading cause of death in youth ten years old or older. Healthcare utilization prior to death by suicide is high in adults, but there is conflicting evidence in youth. The objective of this study was to compare healthcare utilization in youth who died by suicide to youth who died in a motor vehicle accident (MVC) to determine whether healthcare utilization is associated with death by suicide in youth.
Methods
This retrospective case-control study used death records from Coroners/Medical Examiners (C/MEs) for children 11–17 years old who died by suicide (case) and MVC (control) between October 2013 and October 2018 were obtained. Data from the electronic medical record (EMR) at a healthcare system was reviewed. The primary outcome was healthcare utilization. Secondary outcomes included mental health diagnosis. Data was analyzed using Fisher’s Exact Test and considered significant if p < 0.05.
Results
The analysis included 60 youth who died by suicide and 14 youth who died by MVC. Most decedents were male (68%) and white (80%). Mean age at death was 16 years old. Only 25 decedents had a corresponding record in the EMR, with no significant difference based on manner of death (35% suicide vs 29% MVC, p = 0.8). Fourteen decedents had a known mental health diagnosis in their EMR with no difference based on manner of death (p = 0.5).
Conclusions
There was no difference in healthcare utilization or mental health diagnosis in youth who died by suicide compared to youth who died by MVC. Strict reliance on both of these factors when considering youth who may be at risk of suicide is inadequate. Expanding universal suicide screening to other settings, including schools or primary care, can help identify youth at risk for suicide and may prevent unnecessary deaths.
Little is known regarding the healthcare utilization of youth who died by suicide prior to their death.
This study uses a case-control design to investigation healthcare utilization of youth who died by suicide versus youth who died in a motor vehicle crash.
We did not find a significant difference in healthcare utilization between cases and controls. These findings suggest that non-clinical interventions would be useful in detecting suicide risk.
HIGHLIGHTS
DISCLOSURE STATEMENT
No potential conflict of interest was reported by the author(s).
Additional information
Funding
Notes on contributors
Sara Kohlbeck
Sara Kohlbeck, MPH is the Director of the Division of Suicide Prevention at the Comprehensive Injury Center at the Medical College of Wisconsin. Ms. Kohlbeck’s work focuses on systems-level factors that are associated with suicide among youth and adults. She is also a PhD candidate in Public and Community Health at the Institute for Health and Equity at the Medical College of Wisconsin. Her doctoral research focuses on suicide among Wisconsin farmers.
Michael Armanious
Michael Armanious is a Clinical Research Coordinator in the Pediatric Emergency Department. He is currently a master’s in healthcare administration student who would like to focus on mental health utilization and/or Nursing Home management. His long-term goal is to obtain his PhD in Health Administration and become a professor and teach future generations. Outside of work and school, he enjoys serving the community and his church and watching and playing sports.
Michelle Pickett
Michelle Pickett, MD, MS is an Associate Professor in the Department of Pediatrics at the Medical College of Wisconsin. Dr. Pickett is a clinical researcher with a research interest in adolescent healthcare, mainly mental health and sexual health. Dr. Pickett’s career goal is to decrease the rate of sexually transmitted infections in adolescents through improving the diagnosis and treatment of patients.