Prevalence and effects of suicidal ideation diagnosis code position in claims on readmission rate estimates

Suicide Ideation and Attempt Among People With HIV: A Statewide Population-level Cohort Analysis Between 2005 and 2020

BACKGROUND

Risk factors for suicidality among people with HIV (PWH) may evolve over their disease course, particularly as they develop comorbidities such as mental health disorders over time.

SETTING

This study compared the leading risk factors of suicide ideation/attempt among PWH in South Carolina across different combination antiretroviral therapy (cART) eras.

METHODS

A statewide cohort of PWH who were diagnosed between 2005 and 2016, with a follow-up record until 2020, was involved in the study. A Cox proportional hazards model was used to examine the association of suicide ideation/attempt and predictors, including demographics, HIV-related characteristics, and mental health conditions.

RESULTS

Among 8567 PWH, the incidence of suicide ideation/attempt increased from 537.7 per 100,000 person-years [95% confidence interval (CI): 460.2 to 615.1] in the early cART cohort (2005-2008) to 782.5 (95% CI: 697.6 to 867.4) in the late cART cohort (2009-2016). Leading risk factors of suicide ideation/attempt changed across the cART cohort. In the early cART cohort, PWH with suicide ideation/attempt were more likely to be White and diagnosed with bipolar disorder ( P' s < 0.05). In the late cART cohort, suicide ideation/attempt was positively associated with transmission through injection drug use, anxiety, posttraumatic stress disorder, schizophrenia, and personality disorder ( P' s < 0.05).

CONCLUSIONS

Mental health conditions have emerged as more prominent risk factors for suicide ideation/attempt in the late cART cohort. Enhanced access to psychiatric care could facilitate the early identification of mental health conditions, enabling timely counseling or psychosocial interventions that may mitigate mental health issues and, consequently, reduce the likelihood of suicide ideation/attempts among PWH.

Effects of Geography on Risk for Future Suicidal Ideation and Attempts Among Children and Youth

Objective

Geography may influence the relationships of predictors for suicidal ideation (SI) and suicide attempts (SA) in children and youth.

Method

This is a nationwide retrospective cohort study of 124,424 individuals less than 25 years of age using commercial claims data (2011-2015) from the Health Care Cost Institute. Outcomes were time to SI or SA within 3 months after the indexed mental health or substance use disorder (MH/SUD) outpatient visit. Predictors included sociodemographic and clinical characteristics up to 3 years before the index event.

Results

At each follow-up time period, rates of SI and SA varied by the US geographic division (p < .001), and the Mountain Division consistently had the highest rates for both SI and SA (5.44%-10.26% for SI; 0.70%-2.82% for SA). Having MH emergency department (ED) visits in the past year increased the risk of SI by 28% to 65% for individuals residing in the New England, Mid-Atlantic, East North Central, West North Central, and East South Central Divisions. The main effects of geographic divisions were significant for SA (p<0.001). Risk of SA was lower in New England, Mid-Atlantic, South Atlantic, and Pacific (hazard ratios = 0.57, 0.51, 0.67, and 0.79, respectively) and higher in the Mountain Division (hazard ratio = 1.46).

Conclusion

To understand the underlying mechanisms driving the high prevalence of SI and SA in the Mountain Division and the elevated risk of SI after having MH ED visits, future research examining regional differences in risks for SI and SA should include indicators of access to MH ED care and other social determinants of health.

Effects, trends, costs associated with readmission in early-aged patients with suicidal ideation

OBJECTIVE

To examine determinants, trends, and costs associated with 30-day all-cause readmission (R) for suicidal ideation (SI) in early-aged patients.

METHODS

This was a retrospective cohort study using the 2010-2014 Nationwide Readmissions Database. Discharge records for those aged 5-24 with an SI diagnosis were analyzed. Hierarchical models (HMs) were used to assess factors of R, length of stay (LOS), and total costs of Rs.

RESULTS

There were 197,603 SI index admissions (IAs). Of these, 2% had a R. The annualized trend of R rates for all age groups remained constant. Those aged 13-18 had the highest rate of Rs, while IA and R mean total costs were highest for those aged 5-12 (IA, $4,546-$5,822; R, $5,361-$7,113). The strongest risk factors for increasing R included nonelective admission and private hospital ownership. The strongest risk factors for increasing LOS and cost were major/extreme severity of illness and 30-day all-cause R. The intracluster correlation coefficient for the HMs were 0.06, 0.33, and 0.55 for the R, LOS, and cost model, respectively.

CONCLUSIONS

The R rate was highest for those in the 13-18 age group, while the costs were highest for those aged 5-12.