Service Use in the Month and Year Prior to Suicide Among Adults Enrolled in Ohio Medicaid
Abstract
Objectives:
Methods:
Results:
Conclusions:
Methods
Data and Sample
Measures
Service utilization.
Demographic characteristics.
Clinical characteristics.
Analyses
Results
Suicide Incidence Rates
Condition | Suicide decedents (N) | Rate per 100,000 enrollees with condition |
---|---|---|
All suicide decedents | 1,338 | 18.9 |
Any chronic general medical condition | 547 | 16.0 |
Any substance use disorder | 553 | 17.8 |
Any mental disorder | 804 | 22.1 |
Disability eligibility for Medicaid | 582 | 31.4 |
Chronic general medical condition only | 66 | 12.4 |
Substance use disorder only | 58 | 13.6 |
Mental disorder only | 191 | 24.7 |
General medical condition and substance use disorder | 30 | 11.6 |
Mental disorder and substance use disorder | 146 | 28.0 |
Mental disorder and general medical condition | 131 | 34.6 |
General medical condition, substance use disorder, and mental disorder | 194 | 41.7 |
Service Use Prior to Suicide
Timing prior to suicide | Any | General medical and mental health | General medical only | Mental health only | M | SD | Median | IQRa | ||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
N | % | N | % | N | % | N | % | |||||
7 days prior | 365 | 27 | 77 | 6 | 169 | 13 | 119 | 9 | 2.1 | 1.7 | 1 | 1–3 |
30 days prior | 670 | 50 | 239 | 18 | 301 | 22 | 130 | 10 | 4.9 | 6.0 | 3 | 1–5 |
90 days prior | 864 | 65 | 445 | 33 | 327 | 24 | 92 | 7 | 11.2 | 15.9 | 6 | 3–12 |
1 year prior | 1,107 | 83 | 701 | 52 | 362 | 27 | 44 | 3 | 32.6 | 53.8 | 16 | 6–35 |
Characteristics of Decedents by Receipt and Timing of Care
Characteristic | Visit within 30 days (N=670) | Visit within 31–365 days (N=437) | pa | ||
---|---|---|---|---|---|
N | % | N | % | ||
Age | |||||
19–29 | 116 | 17 | 131 | 30 | |
30–49 | 360 | 54 | 212 | 49 | .004 |
50–65 | 194 | 29 | 94 | 22 | .002 |
Sex | |||||
Male | 391 | 58 | 297 | 68 | .02 |
Female | 279 | 42 | 140 | 32 | |
Race-ethnicity | |||||
White, non-Hispanic | 589 | 88 | 373 | 85 | .19 |
Otherb | 81 | 12 | 64 | 15 | |
Medicaid eligibility | |||||
Disability | 455 | 68 | 198 | 45 | <.001 |
Income based | 215 | 32 | 239 | 55 | |
Residence | |||||
Urban | 480 | 72 | 332 | 76 | |
Rural | 190 | 28 | 105 | 24 | .12 |
Any mental disorder | 560 | 84 | 244 | 56 | <.001 |
Type of mental disorder | |||||
Depression | 358 | 53 | 133 | 30 | <.001 |
Anxiety | 292 | 44 | 85 | 19 | <.001 |
Bipolar disorder | 238 | 36 | 84 | 19 | <.001 |
Schizophrenia or psychosis | 148 | 22 | 34 | 8 | <.001 |
Other | 233 | 35 | 84 | 19 | <.001 |
Any substance use disorder | 376 | 56 | 177 | 41 | <.001 |
Any chronic general medical condition | 394 | 59 | 153 | 35 | <.001 |
Mental disorder and substance use disorder | 333 | 50 | 114 | 26 | <.001 |
Mental disorder and chronic general medical condition | 339 | 51 | 110 | 25 | <.001 |
Substance use disorder and chronic medical condition | 239 | 36 | 73 | 17 | <.001 |
Mental disorder, substance use disorder, and chronic general medical condition | 216 | 32 | 58 | 13 | <.001 |
Factors Associated With Type of Visit in the Month Before Suicide
Characteristic | General medical and mental health (N=239) | General medical only (N=301) | Mental health only (N=130) | χ2 | df | p | |||
---|---|---|---|---|---|---|---|---|---|
N | % | N | % | N | % | ||||
Age | 9.3 | 2 | .05 | ||||||
19–29 | 42 | 18 | 42 | 14 | 32 | 25 | |||
30–49 | 135 | 56 | 161 | 53 | 64 | 49 | |||
50–65 | 62 | 26 | 98 | 33 | 34 | 26 | |||
Gender | 3.6 | 1 | .17 | ||||||
Male | 128 | 54 | 183 | 61 | 80 | 62 | |||
Female | 111 | 46 | 118 | 39 | 50 | 38 | |||
Race-ethnicity | 5.4 | 1 | .07 | ||||||
White, non-Hispanic | 218 | 91 | 263 | 87 | 108 | 83 | |||
Other | 21 | 9 | 38 | 13 | 22 | 17 | |||
Medicaid eligibility | 2.1 | 1 | .35 | ||||||
Disability | 166 | 69 | 196 | 65 | 93 | 72 | |||
Income based | 73 | 31 | 105 | 35 | 37 | 28 | |||
Area of residence | 10.6 | 1 | .005 | ||||||
Urban | 162 | 68 | 210 | 70 | 108 | 83 | |||
Rural | 77 | 32 | 91 | 30 | 22 | 17 | |||
Any mental disorder | 235 | 98 | 200 | 66 | 125 | 96 | 117.3 | 1 | <.001 |
Type of mental disorder | |||||||||
Depression | 164 | 69 | 118 | 39 | 76 | 58 | 48.0 | 1 | <.001 |
Anxiety | 131 | 55 | 105 | 35 | 56 | 43 | 21.5 | 1 | <.001 |
Bipolar disorder | 122 | 51 | 62 | 21 | 54 | 42 | 56.5 | 1 | <.001 |
Schizophrenia or psychosis | 68 | 28 | 30 | 10 | 50 | 38 | 51.6 | 1 | <.001 |
Other | 118 | 49 | 69 | 23 | 46 | 35 | 41.1 | 1 | <.001 |
Any substance use disorder | 156 | 65 | 150 | 50 | 70 | 54 | 13.2 | 1 | .001 |
Any chronic general medical condition | 155 | 65 | 187 | 62 | 52 | 40 | 24.0 | 1 | <.001 |
Mental disorder and substance use disorder | 152 | 64 | 116 | 39 | 65 | 50 | 33.5 | 1 | <.001 |
Mental disorder and chronic general medical condition | 153 | 64 | 135 | 45 | 51 | 39 | 27.9 | 1 | <.001 |
Substance use disorder and chronic general medical condition | 102 | 43 | 105 | 35 | 32 | 25 | 12.1 | 1 | .002 |
Mental disorder, substance use disorder, and chronic general medical condition | 100 | 42 | 85 | 28 | 31 | 24 | .9 | 1 | .35 |
Characteristic | Mental health only (N=130)a | Mental health and general medical (N=239)a | ||||
---|---|---|---|---|---|---|
AORb | 95% CI | p | AORb | 95% CI | p | |
Age (reference: 19–29) | ||||||
30–49 | .47 | .25–.88 | .02 | .70 | .40–1.27 | .25 |
50–65 | .39 | .18–.83 | .02 | .57 | .29–1.14 | .11 |
Male (reference: female) | 1.10 | .68–1.79 | .69 | .86 | .58–1.29 | .47 |
Other race (reference: non-Hispanic white) | 1.05 | .53–2.08 | .88 | .63 | .33–1.21 | .17 |
Disability eligibility (reference: income based) | 1.60 | .90–2.86 | .11 | 1.23 | .76–1.99 | .41 |
Rural (reference: urban) | .40 | .22–.72 | .002 | .96 | .62–1.48 | .86 |
Depressive disorderc | 2.71 | 1.64–4.45 | <.001 | 2.67 | 1.78–4.02 | <.001 |
Anxiety disorderc | 1.38 | .83–2.29 | .22 | 1.46 | .97–2.21 | .07 |
Bipolar disorderc | 2.81 | 1.67–4.73 | <.001 | 2.95 | 1.92–4.53 | <.001 |
Schizophrenia or psychosisc | 5.56 | 3.09–10.01 | <.001 | 3.34 | 1.93–5.75 | <.001 |
Other mental disorderc | 1.14 | .67–1.95 | .62 | 2.05 | 1.34–3.14 | .001 |
Any substance use disorderc | .97 | .50–1.87 | .93 | 1.61 | .85–3.08 | .15 |
Any chronic general medical conditionc | .33 | .16–.67 | .002 | 1.08 | .58–2.01 | .81 |
Any substance use disorder and chronic general medical conditionc | .92 | .36–2.35 | .86 | .62 | .28–1.40 | .26 |
Discussion
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Cover: Roosting Birds, by Milton Avery, 1945. Watercolor. Victoria and Albert Museum, London. © The Milton Avery Trust/Artists Rights Society, New York City.
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