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“High rates of suicide after psychiatric hospital discharge have persisted and failed to decrease for decades,” wrote Cynthia A. Fontanella, Ph.D., of the Department of Psychiatry and Behavioral Health at The Ohio State University Wexner Medical Center and colleagues. “These findings support existing quality indicators and highlight the need to improve transitions from inpatient to outpatient mental health care.”
Fontanella and colleagues analyzed Medicaid claims data from 33 states on youth aged 10 years to 18 years who had been admitted to psychiatric hospitals between January 1, 2009, and December 31, 2013. (These states were selected because of the quality and completeness of the managed care claims, the authors noted.) The researchers specifically focused on youth who had inpatient admissions of 1 to 30 days, were discharged home, and were continuously enrolled in Medicaid during the 180 days before the admission and the 30 days after hospital discharge.
To determine deaths by suicide within eight to 180 days of discharge, the researchers linked the Medicaid data with data from the National Death Index. They defined an outpatient mental health visit as “any Medicaid-reimbursed behavioral health visit with a primary mental health diagnosis…, including visits for psychotherapy or pharmacotherapy, partial hospitalization, rehabilitation, and other community-based services, such as case management.”
Of the 139,694 youth admitted to a psychiatric hospital during the study period, 56.5% received a mental health visit within seven days of hospital discharge. Follow-up care within seven days was associated with a 56% lower risk of suicide (adjusted relative risk, 0.44) during the postdischarge period.
Youth who had longer lengths of stay at the hospital, had previously accessed outpatient mental health care, and/or were in foster care were more likely to have received follow-up care within seven days of discharge from a psychiatric hospital. In contrast, youth who were non-Hispanic Black; were older; and/or had a history of comorbid chronic medical conditions, deliberate self-harm, or substance use disorders were less likely to have received follow-up care within seven days of discharge.
In a commentary accompanying the study, David A. Brent, M.D., of the University of Pittsburgh School of Medicine and colleagues reflected on the finding that Black youth were less likely receive a follow-up mental health appointment within one week of discharge from a psychiatric hospital. “This is particularly worrisome because, from 2007 to 2017, the rate of suicide attempts increased 74% and the rate of suicide deaths increased 89% among Black youth, increases that greatly exceeded those for white youth,” Brent and colleagues wrote.
“The goal of such research is not merely to document the sources of disparities but to devise actionable interventions and policies that bridge these gaps in care,” they continued. “We need to label these disparities as what they are: unacceptable. Just as we must address the gaps that occur between transitions in care, we must also bridge gaps that are defined by race, ethnicity, and class, so that all people receive the care that they need and deserve. In so doing, we can reverse the disturbing upward trend in suicide in U.S. youth in general, and in Black youth in particular.”
For related information, see the Psychiatric News article “Alarming Black Youth Suicide Trend Must Be Addressed, Experts Say.”
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