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Miller-Matero LR, Yeh HH, Maffett A, Mooney JT, Sala-Hamrick K, Frank CB, Simon GE, Rossom R, Owen-Smith AA, Lynch FL, Beck A, Waring S, Daida YG, Lu CY, Ahmedani BK. Racial-Ethnic Differences in Receipt of Past-Year Health Care Services Among Suicide Decedents: A Case-Control Study. Psychiatr Serv 2024; 75:124-130. [PMID: 37554000 PMCID: PMC10840630 DOI: 10.1176/appi.ps.20220578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
OBJECTIVE Suicide remains an urgent public health crisis. Although some sociodemographic characteristics are associated with greater suicide risk in the general population, it is unclear whether individuals utilizing health care in the United States have similar suicide incidence patterns. The authors examined whether race-ethnicity is associated with suicide death among patients seeking health care and investigated health care utilization patterns. METHODS Data were collected from electronic health records and government mortality records for patients seeking health care across nine health care systems in the United States. Patients who died by suicide (N=1,935) were matched with patients in a control group (N=19,350) within each health care system. RESULTS Patients who died by suicide were significantly more likely to be White, older, male, living in low-education areas, living in rural areas, or diagnosed as having mental health conditions or were significantly less likely to have commercial insurance (p<0.05). Among most racial-ethnic groups, those who died by suicide had a higher number of past-year mental health, primary care, and total health care visits; for American Indian/Alaska Native patients, the number of health care visits tended to be lower among suicide decedents. CONCLUSIONS These findings suggest that higher past-year health care utilization was associated with increased likelihood of suicide death across several racial-ethnic groups. This observation underscores the need for identifying and managing suicide risk in health care settings, including outside of mental health visits, among most racial-ethnic groups.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Hsueh-Han Yeh
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Anissa Maffett
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Jan T Mooney
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Kelsey Sala-Hamrick
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Cathrine B Frank
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Gregory E Simon
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Rebecca Rossom
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Ashli A Owen-Smith
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Frances L Lynch
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Arne Beck
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Stephen Waring
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Yihe G Daida
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Christine Y Lu
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Brian K Ahmedani
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
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Haroz EE, Goklish N, Walsh CG, Cwik M, O’Keefe VM, Larzelere F, Garcia M, Minjarez T, Barlow A. Evaluation of the Risk Identification for Suicide and Enhanced Care Model in a Native American Community. JAMA Psychiatry 2023; 80:675-681. [PMID: 37195713 PMCID: PMC10193257 DOI: 10.1001/jamapsychiatry.2022.5068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/18/2022] [Indexed: 05/18/2023]
Abstract
Importance There are many prognostic models of suicide risk, but few have been prospectively evaluated, and none has been developed specifically for Native American populations. Objective To prospectively validate a statistical risk model implemented in a community setting and evaluate whether use of this model was associated with improved reach of evidence-based care and reduced subsequent suicide-related behavior among high-risk individuals. Design, Setting, and Participants This prognostic study, done in partnership with the White Mountain Apache Tribe, used data collected by the Apache Celebrating Life program for adults aged 25 years or older identified as at risk for suicide and/or self-harm from January 1, 2017, through August 31, 2022. Data were divided into 2 cohorts: (1) individuals and suicide-related events from the period prior to suicide risk alerts being active (February 29, 2020) and (2) individuals and events from the time after alerts were activated. Main Outcomes and Measures Aim 1 focused on a prospective validation of the risk model in cohort 1. Aim 2 compared the odds of repeated suicide-related events and the reach of brief contact interventions among high-risk cases between cohort 2 and cohort 1. Results Across both cohorts, a total of 400 individuals identified as at risk for suicide and/or self-harm (mean [SD] age, 36.5 [10.3] years; 210 females [52.5%]) had 781 suicide-related events. Cohort 1 included 256 individuals with index events prior to active notifications. Most index events (134 [52.5%]) were for binge substance use, followed by 101 (39.6%) for suicidal ideation, 28 (11.0%) for a suicide attempt, and 10 (3.9%) for self-injury. Among these individuals, 102 (39.5%) had subsequent suicidal behaviors. In cohort 1, the majority (220 [86.3%]) were classified as low risk, and 35 individuals (13.3%) were classified as high risk for suicidal attempt or death in the 12 months after their index event. Cohort 2 included 144 individuals with index events after notifications were activated. For aim 1, those classified as high risk had a greater odds of subsequent suicide-related events compared with those classified as low risk (odds ratio [OR], 3.47; 95% CI, 1.53-7.86; P = .003; area under the receiver operating characteristic curve, 0.65). For aim 2, which included 57 individuals classified as high risk across both cohorts, during the time when alerts were inactive, high-risk individuals were more likely to have subsequent suicidal behaviors compared with when alerts were active (OR, 9.14; 95% CI, 1.85-45.29; P = .007). Before the active alerts, only 1 of 35 (2.9%) individuals classified as high risk received a wellness check; after the alerts were activated, 11 of 22 (50.0%) individuals classified as high risk received 1 or more wellness checks. Conclusions and Relevance This study showed that a statistical model and associated care system developed in partnership with the White Mountain Apache Tribe enhanced identification of individuals at high risk for suicide and was associated with a reduced risk for subsequent suicidal behaviors and increased reach of care.
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Affiliation(s)
- Emily E. Haroz
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Novalene Goklish
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Colin G. Walsh
- Department of Biomedical Informatics, Department of Medicine, Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary Cwik
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Victoria M. O’Keefe
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Francene Larzelere
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Mitchell Garcia
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Tina Minjarez
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Allison Barlow
- Johns Hopkins Center for Indigenous Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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