Exploring Service Use Disparities among Suicidal Black Youth in a Suicide Prevention Care Coordination Intervention

Engagement in child psychiatry department appointments: An analysis of electronic medical records in one safety-net hospital in New England, USA

OBJECTIVE

This study examined whether being scheduled in a screening clinic versus scheduled directly with a long-term provider to conduct a mental health intake (MHI) is associated with engagement in child psychiatry services in New England, USA.

METHOD

We used electronic medical record data from one safety-net hospital serving a predominantly low-income and minoritised population. The study sample included 815 youths aged 0 to 25 years, referred or scheduled for a MHI between 1 January 2016 and 31 December 2016. We used chi-square and t-tests to examine the association between referral pathways and engagement, logistic regression to understand the relationship between youth's socio-demographic characteristics and referral pathways, and logistic and Poisson regressions to assess potential moderating effects of socio-demographic characteristics on engagement.

RESULTS

The mean age of the study population was 12 years; 46% were female, and the majority had public health insurance (84%) and lived in high social vulnerability areas (65%). Less than half of the youth attended the first scheduled MHI visit. Those scheduled with the screening clinic were less likely than those scheduled with the provider to ever attend a MHI appointment. Spanish-speakers were more likely to be directly scheduled with a provider (Odds Ratio, OR 0.48; 95% CI: 0.32, 0.73), while those with public health insurance were more likely to be scheduled with the screening clinic (OR 0.56; 95% CI: 0.43, 0.96). Spanish-speaking status and areas social vulnerability scores moderated the relationship between the referral pathway and engagement in psychiatric appointments.

CONCLUSIONS

The study highlights the need for psychiatric services to evaluate how MHI referral procedures may mitigate barriers to care and facilitate engagement for youth at high risk of not attending psychiatric service appointments.

Factors Associated with Suicide Risk Behavior Outcomes Among Black High School Adolescents

There is an urgent need for youth suicide research, particularly among Black adolescents, for whom there have been significant increases over time. This study examines associations between eight covariates and suicide ideation, planning, and attempts among a national sample of Black high school adolescents to inform prevention efforts. Utilizing the 2019 National Youth Risk Behavior Survey data, a sample of N = 6225 Black high school participants was analyzed. A weighted classification tree and network analysis were used to visualize data features, and weighted multinomial ordered logistic regression analyses with multiple imputation pooled using Rubin's rules were performed. Suicide ideation rates of 16% were found in the sample and a higher reported rate of suicide attempts (56%) for those who have reported both ideation and planning. Interpersonal and multilevel factors, including suffering from bullying/cyberbullying, carrying a weapon, or being a sexual minority, were significantly associated with all three suicide behaviors. Findings support an interrelated and multilevel nature of suicide risk factors. Prevention programs for Black adolescents should consider the intersectionality of identities and experiences.

Informing Equitable Prevention Practices: A Statewide Disaggregated Analysis of Suicide for Ethnoracially Minoritized Adolescents

The increase in adolescent suicide rates in the United States is a pervasive public health issue, and ethnoracial youth with diverse identities are disproportionately impacted, yet less studied. National planning efforts reinforce state-level approaches to suicide prevention through an equitable lens to prevent adolescent suicide. This study examined disaggregated state-level data over time to determine changes to suicide outcomes based on race/ethnicity, sex, sexual orientation, and the intersection of these identities and determined which sub-groups had higher odds of suicide outcomes. Data from the 1991-2019 Centers for Disease Control and Prevention Youth Risk Behavioral Surveillance System were analyzed for 17,419 ethnoracially minoritized high school adolescents in North Carolina. Descriptive analyses and multinominal logistic regression models were employed. Findings indicated that subgroups within categories of ethnoracial populations, specifically Black female adolescents unsure of their sexual orientation, reported higher rates of suicide attempts. Additionally, Multiracial adolescents reported higher means for suicide consideration and attempts over time. Recommendations for investigating state-level suicide data by focusing on diverse intersecting identities to illuminate areas for potential prevention efforts and support health equity are provided.