Henry Ford Health, Center for Health Policy & Health Services Research, 1 Ford Place, Suite 3A, Detroit, MI, 48202, USA.
Henry Ford Health, Behavioral Health Services, Detroit, MI, USA.
Transl Psychiatry. 2022 Jul 13;12(1):280. doi: 10.1038/s41398-022-02051-4.
Health systems are essential for suicide risk detection. Most efforts target people with mental health (MH) diagnoses, but this only represents half of the people who die by suicide. This study seeks to discover and validate health indicators of suicide death among those with, and without, MH diagnoses. This case-control study used statistical modeling with health record data on diagnoses, procedures, and encounters. The study included 3,195 individuals who died by suicide from 2000 to 2015 and 249,092 randomly selected matched controls, who were age 18+ and affiliated with nine Mental Health Research Network affiliated health systems. Of the 202 indicators studied, 170 (84%) were associated with suicide in the discovery cohort, with 148 (86%) of those in the validation cohort. Malignant cancer diagnoses were risk factors for suicide in those without MH diagnoses, and multiple individual psychiatric-related indicators were unique to the MH subgroup. Protective effects across MH-stratified models included diagnoses of benign neoplasms, respiratory infections, and utilization of reproductive services. MH-stratified latent class models validated five subgroups with distinct patterns of indicators in both those with and without MH. The highest risk groups were characterized via high utilization with multiple healthcare concerns in both groups. The lowest risk groups were characterized as predominantly young, female, and high utilizers of preventive services. Healthcare data include many indicators of suicide risk for those with and without MH diagnoses, which may be used to support the identification and understanding of risk as well as targeting of prevention in health systems.
健康系统对于自杀风险的检测至关重要。大多数努力都针对有心理健康诊断的人，但这只代表了自杀死亡人数的一半。本研究旨在发现和验证有和没有心理健康诊断的人自杀死亡的健康指标。这项病例对照研究使用了统计建模方法，利用了 2000 年至 2015 年期间的诊断、程序和就诊记录数据。该研究包括 3195 名自杀死亡的个体和 249092 名随机选择的匹配对照个体，他们年龄在 18 岁及以上，隶属于九个心理健康研究网络附属的健康系统。在所研究的 202 个指标中，有 170 个（84%）在发现队列中与自杀相关，其中 148 个（86%）在验证队列中与自杀相关。恶性癌症诊断是无心理健康诊断者自杀的危险因素，而多个个体精神相关指标是心理健康亚组所特有的。跨越心理健康分层模型的保护效应包括良性肿瘤、呼吸道感染和生殖服务的诊断。心理健康分层潜在类别模型在有和没有心理健康的个体中都验证了五个具有不同指标模式的亚组。风险最高的群体特征是两组中都有多个医疗保健问题的高利用率。风险最低的群体特征是主要为年轻、女性和预防性服务的高利用率。医疗保健数据包括有和没有心理健康诊断的个体的许多自杀风险指标，这些指标可用于支持识别和理解风险，以及在健康系统中针对预防目标。
