Ahmedani Brian K, Stewart Christine, Simon Gregory E, Lynch Frances, Lu Christine Y, Waitzfelder Beth E, Solberg Leif I, Owen-Smith Ashli A, Beck Arne, Copeland Laurel A, Hunkeler Enid M, Rossom Rebecca C, Williams Keoki
*Henry Ford Health System, Center for Health Policy and Health Services Research, Detroit, MI †Group Health Cooperative, Group Health Research Institute, Seattle, WA ‡Kaiser Permanente Northwest, Center for Health Research, Portland, OR §Department of Population Medicine and Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA ∥Kaiser Permanente Hawaii, Center for Health Research, Honolulu, HI ¶HealthPartners, Institute for Education and Research, Bloomington, MN #Kaiser Permanente Georgia, Center for Health Research, Atlanta, GA **Kaiser Permanente Colorado, Institute for Health Research, Denver, CO ††Baylor Scott & White Health, Center for Applied Health Research, Temple, TX ‡‡Kaiser Permanente Northern California, Division of Research, Oakland, CA.
Med Care. 2015 May;53(5):430-5. doi: 10.1097/MLR.0000000000000335.
Suicide is a public health concern, but little is known about the patterns of health care visits made before a suicide attempt, and whether those patterns differ by race/ethnicity.
To examine racial/ethnic variation in the types of health care visits made before a suicide attempt, when those visits occur, and whether mental health or substance use diagnoses were documented.
Retrospective, longitudinal study, 2009-2011.
22,387 individuals who attempted suicide and were enrolled in the health plan across 10 health systems in the Mental Health Research Network.
Cumulative percentage of different types of health care visits made in the 52 weeks before a suicide attempt, by self-reported racial/ethnicity and diagnosis. Data were from the Virtual Data Warehouse at each site.
Over 38% of the individuals made any health care visit within the week before their suicide attempt and ∼95% within the preceding year; these percentages varied across racial/ethnic groups (P<0.001). White individuals had the highest percentage of visits (>41%) within 1 week of suicide attempt. Asian Americans were the least likely to make visits within 52 weeks. Hawaiian/Pacific Islanders had proportionally the most inpatient and emergency visits before an attempt, but were least likely to have a recorded mental health or substance use diagnosis. Overall, visits were most common in primary care and outpatient general medical settings.
This study provides temporal evidence of racial/ethnic differences in health care visits made before suicide attempt. Health care systems can use this information to help focus the design and implementation of their suicide prevention initiatives.
自杀是一个公共卫生问题，但对于自杀未遂前的医疗就诊模式以及这些模式是否因种族/族裔而异，人们知之甚少。
研究自杀未遂前医疗就诊类型的种族/族裔差异、就诊时间，以及是否记录了心理健康或物质使用诊断。
2009 - 2011年的回顾性纵向研究。
22387名自杀未遂且加入了心理健康研究网络中10个卫生系统的健康计划的个体。
根据自我报告的种族/族裔和诊断，统计自杀未遂前52周内不同类型医疗就诊的累积百分比。数据来自各站点的虚拟数据仓库。
超过38%的个体在自杀未遂前一周内进行了任何医疗就诊，约95%的个体在前一年进行了就诊；这些百分比在不同种族/族裔群体中有所不同（P<0.001）。白人个体在自杀未遂前1周内就诊的百分比最高（>41%）。亚裔美国人在52周内就诊的可能性最小。夏威夷/太平洋岛民在自杀未遂前住院和急诊就诊的比例相对最高，但记录有心理健康或物质使用诊断的可能性最小。总体而言，就诊在初级保健和门诊普通医疗环境中最为常见。
本研究提供了自杀未遂前医疗就诊种族/族裔差异的时间证据。医疗系统可利用这些信息来帮助聚焦自杀预防举措的设计和实施。
