Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio;
Department of Psychiatry and Behavioral Health, The Ohio State University Medical Center, The Ohio State University, Columbus, Ohio.
Pediatrics. 2021 Apr;147(4). doi: 10.1542/peds.2020-011585. Epub 2021 Mar 8.
To examine characteristics and health service use patterns of suicide decedents with a history of child welfare system involvement to inform prevention strategies and reduce suicide in this vulnerable population.
A retrospective matched case-control design (120 suicide decedents and 1200 matched controls) was implemented. Suicide decedents included youth aged 5 to 21 who died by suicide and had an open case in Ohio's Statewide Automated Child Welfare Information System between 2010 and 2017. Controls were matched to suicide decedents on sex, race, and ethnicity. Comparisons were analyzed by using conditional logistic regressions to control for matching between the suicide and control groups.
Youth in the child welfare system who died by suicide were significantly more likely to experience out-of-home placements and be diagnosed with mental and physical health conditions compared with controls. Suicide decedents were twice as likely to access mental health services in the 1 and 6 months before death, regardless of the health care setting. A significantly higher percentage of suicide decedents used physical health services 6 months before their death or index date. Emergency department visits for both physical and mental health conditions were significantly more likely to occur among suicide decedents.
Suicide decedents involved in the child welfare system were more likely to use both mental and physical health care services in the months before their death or index date. Findings suggest that youth involved in the child welfare system may benefit from suicide prevention strategies in health care settings.
研究有儿童福利系统介入史的自杀死亡者的特征和卫生服务使用模式，为制定预防策略提供信息，并减少这一弱势群体的自杀行为。
采用回顾性匹配病例对照设计（120 例自杀死亡者和 1200 例匹配对照者）。自杀死亡者包括 2010 年至 2017 年期间在俄亥俄州全州自动儿童福利信息系统中有开放案件且年龄在 5 至 21 岁之间自杀的青少年。对照者与自杀死亡者按性别、种族和民族进行匹配。通过条件逻辑回归进行比较，以控制自杀组和对照组之间的匹配。
与对照组相比，自杀的儿童福利系统中的青少年更有可能经历家庭外安置，并被诊断出患有精神和身体健康状况。无论医疗保健环境如何，自杀死亡者在死亡前 1 个月和 6 个月内接受心理健康服务的可能性是对照组的两倍。在死亡前 6 个月或索引日期之前，有更高比例的自杀死亡者使用了身体健康服务。自杀死亡者因身体和心理健康状况到急诊就诊的可能性显著更高。
参与儿童福利系统的自杀死亡者在死亡或索引日期前的几个月内更有可能使用精神和身体健康保健服务。研究结果表明，参与儿童福利系统的青少年可能受益于卫生保健机构中的自杀预防策略。
