1 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario.
2 The Institute for Clinical Evaluative Sciences, Toronto, Ontario.
Can J Psychiatry. 2018 Mar;63(3):161-169. doi: 10.1177/0706743717741060. Epub 2017 Nov 9.
Prior year medical care was compared among youth dying by suicide to their peers. Effect modification of these associations by age or place of residency (rural versus larger community sizes) was examined in a large, medically insured population.
This population-based case control study used data from the Office of the Chief Coroner in Ontario, Canada, linked to health care administrative data to examine associations between medical care for mental health or other reasons (versus no medical care) and suicide. Decedents ( n = 1203 males and n = 454 females) were youth (aged 10 to 25 years) who died by suicide in Ontario between April 2003 and March 2014, inclusive. Peers of the same ages were frequency matched to decedents on sex and place of residency. Logistic regression was used to calculate odds ratios and 95% confidence intervals and to test effect modification.
Associations with mental health care were stronger in decedents than peers with a gradation of care (i.e., outpatient only, emergency department [ED], inpatient care) in both sexes. However, these associations were weaker among youth living in rural communities. Furthermore, older males (aged 18 to 25 years) were less likely than younger males (aged 10 to 17 years) to access the ED (ambulatory care only). This decrease was observed in rural and larger communities alongside no increase in medical care for other reasons.
Geographical and age-related barriers to mental health care exist for youth who die by suicide. Preventive efforts can address these barriers, intervening early and integrating services, including the ED.
将自杀死亡的青年与同龄人进行比较，研究他们在过去一年中的医疗服务情况。在一个大型的、有医疗保险的人群中，研究了年龄或居住地（农村与较大社区）对这些关联的影响。
本基于人群的病例对照研究使用了加拿大安大略省首席验尸官办公室的数据，并与医疗保健管理数据相关联，以调查精神健康或其他原因（与无医疗服务）的医疗服务与自杀之间的关联。死者（n=1203 名男性和 n=454 名女性）是在安大略省 2003 年 4 月至 2014 年 3 月期间自杀的 10 至 25 岁的青年。与死者同年龄和居住地的同龄人按性别和居住地进行频数匹配。使用逻辑回归计算优势比和 95%置信区间，并检验效应修饰。
在男女两性中，与精神保健服务的关联在死者中比同龄人更强，具有服务分级（即仅门诊、急诊室[ED]、住院护理）。然而，这些关联在农村社区的青年中较弱。此外，年龄较大的男性（18 至 25 岁）比年龄较小的男性（10 至 17 岁）更不可能去急诊室（仅门诊）。这种情况在农村和较大的社区中都存在，同时其他原因的医疗服务也没有增加。
对于自杀死亡的青年来说，存在与地理和年龄相关的精神保健服务障碍。预防工作可以解决这些障碍，尽早干预并整合服务，包括急诊室。
