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.

中文翻译：

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美国国家医疗补助样本中儿童和青少年自杀危机前后的心理健康服务使用情况

介绍

因自杀意念/企图而去急诊室 (ED) 就诊后的心理健康随访是预防年轻人自杀的重要组成部分。

方法

我们分析了 2009 年至 2012 年医疗补助分析摘录，其中包括 62,139 例治疗后出院急诊室就诊和 30,312 例 6 至 17 岁患者因自杀意念/企图而入院急诊室的病例。我们使用混合效应逻辑回归模型来检查患者在急诊室就诊之前的医疗保健利用率与完成 30 天心理健康随访的可能性之间的关联。

结果

总体而言，对于治疗和出院急诊就诊，49% 的人进行了 30 天的后续心理健康就诊，而对于急诊入院入院，67% 的人进行了 30 天的后续心理健康就诊。在急诊室就诊前 30 天内进行过心理健康就诊是完成心理健康随访的最强预测因素（急诊室治疗和出院：调整后的比值比 [AOR] 11.01；95% 置信区间 [CI] 9.82 –12.35；急诊室至医院 AOR 4.60；95% CI 3.16–6.68）。在急诊就诊前 30 天内没有进行心理健康就诊的人中，只有 25% 进行过门诊心理健康随访。在急诊室就诊前 30 天内进行过一般医疗保健就诊与完成心理健康随访就诊的关联性要小得多（急诊室治疗和出院：AOR 1.17；95% CI 1.09-1.24；急诊室到-医院 AOR 1.25；95% CI 1.17–1.34）。

结论

没有流动精神卫生保健来源的年轻人在因自杀意念或自杀企图而去急诊室就诊后，心理健康随访率较低，并且有机会改善最近接受过一般医疗保健就诊的青少年的心理健康随访。