A National Comparison of Suicide Among Medicaid and Non-Medicaid Youth

The burden of attempted hanging and drowning presenting to hospitals in Ireland between 2007 and 2019: a national registry-based study

PURPOSE

To measure the impact of hospital-treated self-harm by hanging and drowning in Ireland in 2007-2019 and identify risk factors for these methods of self-harm.

METHOD

Data on all self-harm presentations to Irish hospitals between 2007 and 2019 were obtained from the National Self-Harm Registry Ireland, a national self-harm surveillance system. Multinomial regression was used to explore factors associated with attempted hanging and drowning.

RESULTS

The age-standardised incidence rate of attempted hanging and drowning increased by 126% and 45%, respectively, between 2007 and 2019. The incidence of both methods was highest among young people aged 15-24 years. The odds of presenting to hospital for attempted hanging were highest in males (aOR 2.85, 95% CI 2.72-3.00), people experiencing homelessness (aOR 1.32, 95% CI 1.16-1.49) and individuals living in the capital, Dublin (aOR 1.23, 95% CI 1.17-1.29). The odds of presenting for attempted drowning were highest in males (aOR 1.68, 95% CI 1.58-1.78) and people experiencing homelessness (aOR 2.69, 95% CI 2.41-2.99).

CONCLUSION

The incidence of hospital-treated self-harm by hanging and drowning is increasing in Ireland and is highest among adolescents and young adults. Males and people experiencing homelessness may be at highest risk and warrant targeted preventive interventions.

Association between race and socioeconomic factors and suicide-related 911 call rate

The American 911 emergency call system fulfills a unique role in preventing suicide and is universally available to all residents suffering a mental health crisis. Previous studies have found disparities between socioeconomic and racial groups in mental health treatment and in help-seeking behaviors. However, very few studies have analyzed disparities in the use of the 911 system for mental health or suicidal crises. The present study conducted negative binomial regression analyses to determine if an increase in suicide-related 911 call rate is associated with race and socioeconomic characteristics in Western King County, Washington. We used the geographic locations of 4823 suicide-related calls from January 2019 to June 2020 to contrast against 2019 demographic data from the Census Bureau. We found increased percentage of Black, Indigenous and People of Color (BIPOC), residents relying on private health insurance, and lower education levels were associated with a decreased suicide-related 911 call rate. We found residents relying on public health insurance to be associated with an increased suicide-related 911 call rate. Future research should explore how residents use 911 in mental health crises to further improve public suicide prevention efforts. Our findings demonstrate how areas with poor health care options may rely more on the 911 system amidst a suicidal crisis.

Examining the Examiners: How Medical Death Investigators Describe Suicidal, Homicidal, and Accidental Death

This study describes differences in medicolegal death investigators' written descriptions for people who died by homicide, suicide, or accident. We evaluated 17 years of death descriptions from a midsized metropolitan midwestern county in the United States to assess how death investigators psychologically respond to different manners of death (N = 10,408 cases). Automated text analyses suggest investigators describe accidental deaths with more immediacy relative to homicides, while they also described suicidal deaths in less emotional terms than homicides as well. These data suggest medicolegal death investigators have different psychological reactions to circumstances and manners of death as indicated by their professional writing. Future research may surface context-specific psychological reactions to vicarious trauma that could inform the design or personalization of workplace-coping interventions.

Predictors of Intentional Self -Harm Among Medicaid Mental Health Clinic Clients In New York

BACKGROUND

Behavioral health outpatients are at risk for self-harm. Identifying individuals or combination of risk factors could discriminate those at elevated risk for self-harm.

METHODS

The study population (N = 248,491) included New York State Medicaid-enrolled individuals aged 10 to 64 with mental health clinic services between November 1, 2015 to November 1, 2016. Self-harm episodes were defined using ICD-10 codes from emergency department and inpatient visits. Multi-predictor logistic regression models were fit on a subsample of the data and compared to a testing sample based on discrimination performance (Area Under the Curve or AUC).

RESULTS

Of N = 248,491 patients, 4,224 (1.70%) had an episode of intentional self-harm. Factors associated with increased self-harm risk were age 17-25, being female and having recent diagnoses of depression (AOR=4.3, 95%CI: 3.6-5.0), personality disorder (AOR=4.2, 95%CI: 2.9-6.1), or substance use disorder (AOR=3.4, 95%CI: 2.7-4.3) within the last month. A multi-predictor logistic regression model including demographics and new psychiatric diagnoses within 90 days prior to index date had good discrimination and outperformed competitor models on a testing sample (AUC=0.86, 95%CI:0.85-0.87).

LIMITATIONS

New York State Medicaid data may not be generalizable to the entire U.S population. ICD-10 codes do not allow distinction between self-harm with and without intent to die.

CONCLUSIONS

Our results highlight the usefulness of recency of new psychiatric diagnoses, in predicting the magnitude and timing of intentional self-harm risk. An algorithm based on this finding could enhance clinical assessments support screening, intervention and outreach programs that are at the heart of a Zero Suicide prevention model.

Estimating the association between mental health disorders and suicide: a review of common sources of bias and challenges and opportunities for US-based research

Purpose of review

The purpose of this review is to 1) illuminate prevalent methodological approaches and estimates of association between mental health diagnoses and suicide from the meta-analytic literature; 2) discuss key internal and external validity concerns with these estimates; and 3) highlight some of the unique attributes and challenges in US-based suicide research and opportunities to move the evidence base forward.

Recent findings

Globally, there is considerable variability in measures of association between mental health disorders and suicide and a growing debate over methodological approaches to this research. A high suicide incidence makes the US an outlier, and the decentralized nature of US administrative data poses a unique challenge to data linkage that could otherwise advance this research.

Summary

We offer methodological considerations for future research and discuss opportunities made possible by the recent expansion of the US National Violent Death Reporting System to a nationwide registry.