Mental Health Service Use Before and After a Suicidal Crisis Among Children and Adolescents in a United States National Medicaid Sample

Acad Pediatr. 2021 Sep-Oct;21(7):1171-1178. doi: 10.1016/j.acap.2021.04.026. Epub 2021 May 28.

Abstract

Introduction: Mental health follow-up after an emergency department (ED) visit for suicide ideation/attempt is a critical component of suicide prevention for young people.

Methods: We analyzed 2009 to 2012 Medicaid Analytic EXtract for 62,139 treat-and-release ED visits and 30,312 ED-to-hospital admissions for suicide ideation/attempt among patients ages 6 to 17 years. We used mixed-effects logistic regression models to examine associations between patients' health care utilization prior to the ED visit and likelihood of completing a 30-day mental health follow-up visit.

Results: Overall, for treat-and-release ED visits, 49% had a 30-day follow-up mental health visit, and for ED-to-hospital admissions, 67% had a 30-day follow-up mental health visit. Having a mental health visit in the 30 days preceding the ED visit was the strongest predictor of completing a mental health follow-up visit (ED treat-and-release: adjusted odds ratio [AOR] 11.01; 95% confidence interval [CI] 9.82-12.35; ED-to-hospital AOR 4.60; 95% CI 3.16-6.68). Among those with no mental health visit in the 30 days preceding the ED visit, only 25% had an ambulatory mental health follow-up visit. Having a general health care visit in the 30 days preceding the ED visit had a much smaller association with completing a mental health follow-up visit (ED treat-and-release: AOR 1.17; 95% CI 1.09-1.24; ED-to-hospital AOR 1.25; 95% CI 1.17-1.34).

Conclusions: Young people without an existing source of ambulatory mental health care have low rates of mental health follow-up after an ED visit for suicide ideation or attempt, and opportunities exist to improve mental health follow-up for youth with recent general health care visits.

Keywords: adolescents; emergency care; mental health; suicide.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Child
  • Emergency Service, Hospital
  • Humans
  • Medicaid
  • Mental Health Services*
  • Suicidal Ideation*
  • Suicide, Attempted
  • United States