National Trends in Mental Health–Related Emergency Department Visits Among Youth, 2011-2020

JAMA, Год журнала: 2023, Номер 329(17), С. 1469 - 1469

Опубликована: Май 2, 2023

There has been increasing concern about the burden of mental health problems among youth, especially since COVID-19 pandemic. Trends in health-related emergency department (ED) visits are an important indicator unmet outpatient needs.To estimate annual trends ED US children, adolescents, and young adults between 2011 2020.Data from to 2020 National Hospital Ambulatory Medical Care Survey, cross-sectional national probability sample survey EDs, was used examine for youths aged 6 24 years (unweighted = 49 515).Mental included associated with psychiatric or substance use disorders were identified by International Classification Diseases-Ninth Revision, Clinical Modification (ICD-9-CM; 2011-2015) ICD-10-CM (2016-2020) discharge diagnosis codes reason-for-visit (RFV) codes. We estimated proportion pediatric 2020. Subgroup analyses performed demographics broad diagnoses. Multivariable-adjusted logistic regression factors independently controlling period effects.From 2020, weighted number increased 4.8 million (7.7% all visits) 7.5 (13.1% average percent change 8.0% (95% CI, 6.1%-10.1%; P < .001). Significant linearly seen adults, greatest increase adolescents across sex race ethnicity. While types significantly increased, suicide-related demonstrated 0.9% 4.2% (average change, 23.1% [95% 19.0%-27.5%]; .001).Over last 10 years, reasons approximately doubled, including a 5-fold visits. These findings underscore urgent need improve crisis service capacity people, children experiencing suicidal symptoms.

Язык: Английский

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Youth Suicide During the First Year of the COVID-19 Pandemic

PEDIATRICS, Год журнала: 2023, Номер 151(3)

Опубликована: Фев. 15, 2023

To identify potential differential changes in youth suicide deaths associated with the coronavirus disease (COVID-19) pandemic to better inform prevention strategies.

Язык: Английский

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Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems

American Journal of Psychiatry, Год журнала: 2022, Номер 179(6), С. 422 - 433

Опубликована: Май 23, 2022

Suicide rates among ethnoracially minoritized youth (i.e., of color) peak before the age 30, and striking disparities in access to mental health services have been identified this group. However, suicide prevention strategies yet fully address structural racism as a mechanism producing risk, protective factors, quality effective intervention for color. Such an approach is critical provide more culturally responsive care. Through adapted socio-ecological model, authors propose Structural Racism Prevention Systems Framework illustrate pathways through which impacts color United States. The contextualize impact three key settings where occurs: services, schools, interface between crisis care law enforcement. posit that attention must be paid intersection mutually reinforcing, interdependent systems rather than isolation. then recommendations prevention, including macro-level interventions improve societal conditions, research inform solutions, training approaches institutional racism, clinical racial trauma on youths families.

Язык: Английский

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Suicide in young people: screening, risk assessment, and intervention

BMJ, Год журнала: 2023, Номер unknown, С. e070630 - e070630

Опубликована: Апрель 24, 2023

Abstract Suicide is the fourth leading cause of death among young people worldwide and third those in US. This review outlines epidemiology suicide suicidal behavior people. It discusses intersectionality as an emerging framework to guide research on prevention highlights several clinical community settings that are prime targets for implementation effective treatment programs interventions aimed at rapidly reducing rate provides overview current approaches screening assessment risk commonly used tools measures. universal, selective, indicated evidence based focused components psychosocial with strongest risk. Finally, strategies considers future directions questions challenging field.

Язык: Английский

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Suicide Risk in Adolescents During the COVID-19 Pandemic

PEDIATRICS, Год журнала: 2022, Номер 149(2)

Опубликована: Янв. 3, 2022

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic created high levels of psychological distress and may have increased suicide risk. METHODS We used the 4-item Ask Suicide-Screening Questions (ASQ) to assess risk among all patients 12 24 years age at a children’s hospital. compared demographics, encounter type (telehealth or face-to-face [F2F]), screening results from April June 2020 (T2) those (T1). RESULTS Fewer were seen T2 than T1 (17 986 vs 863). A greater proportion visits by telehealth (0% 43%). rate positive screens was higher in (12.2% 11.1%, adjusted odds ration [aOR], 1.24; 95% confidence interval [CI], 1.15–1.35). screen for older (aOR 1.12 years; CI, 1.10–1.14), female (aOR, 2.23; 2.00–2.48), with public versus private insurance 1.88; 1.72–2.07), lower Black White 0.85; 0.77–0.95). Rates highest inpatients (20.0%), intermediate emergency department (14.4%), lowest outpatient clinics (9.9%) (P &lt; .05). CONCLUSIONS adolescents rose pandemic’s early months differences related sociodemographics visit type. Changes health care delivery highlight complexities assessing responding mental needs adolescents. Additional research might determine effects methods patient populations on results.

Язык: Английский

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Decoding Suicide Decedent Profiles and Signs of Suicidal Intent Using Latent Class Analysis

JAMA Psychiatry, Год журнала: 2024, Номер 81(6), С. 595 - 595

Опубликована: Март 20, 2024

Suicide rates in the US increased by 35.6% from 2001 to 2021. Given that most individuals die on their first attempt, earlier detection and intervention are crucial. Understanding modifiable risk factors is key effective prevention strategies.

Язык: Английский

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Prediction of Suicide Attempts and Suicide-Related Events Among Adolescents Seen in Emergency Departments

JAMA Network Open, Год журнала: 2023, Номер 6(2), С. e2255986 - e2255986

Опубликована: Фев. 15, 2023

Screening adolescents in emergency departments (EDs) for suicidal risk is a recommended strategy suicide prevention. Comparing screening measures on predictive validity could guide ED clinicians choosing tool.To compare the Ask Suicide-Screening Questions (ASQ) instrument with Computerized Adaptive Screen Suicidal Youth (CASSY) prediction of behavior among seen EDs, across demographic and clinical strata.The Emergency Department Study Teens at Risk Suicide prospective, random-series, multicenter cohort study that recruited adolescents, oversampled those psychiatric symptoms, who presented to from July 24, 2017, through October 29, 2018, 3-month follow-up assess occurrence behavior. The included 14 pediatric members Pediatric Care Applied Research Network 1 Indian Health Service ED. Statistical analysis was performed May 2021 January 2023.This used model outcomes. primary outcome attempt (SA), secondary suicide-related visits or hospital within 3 months baseline; both were assessed by an interviewer blinded baseline information. ASQ 4-item questionnaire surveys ideation lifetime SAs. A positive response nonresponse any item indicates risk. CASSY computerized adaptive tool always includes items mean 8 additional items. CASSY's continuous predicted probability SA.Of 6513 available, 4050 enrolled, 3965 completed assessments, 2740 (1705 girls [62.2%]; [SD] age enrollment, 15.0 [1.7] years; 469 Black participants [17.1%], 678 Hispanic [24.7%], 1618 White [59.1%]) screenings follow-ups. showed similar sensitivity (0.951 [95% CI, 0.918-0.984] vs 0.945 0.910-0.980]), specificity (0.588 0.569-0.607] 0.643 0.625-0.662]), value (0.127 0.109-0.146] 0.144 0.123-0.165]), negative (both 0.995 0.991-0.998], respectively). Area under receiver operating characteristic curve findings patients physical symptoms (ASQ, 0.88 0.81-0.95] CASSY, 0.94 0.91-0.96]). Among better than (0.72 0.68-0.77] 0.57 0.55-0.59], respectively).This suggests are appropriate universal EDs. For small subset shows greater validity.

Язык: Английский

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Exploration of Race and Ethnicity, Sex, Sport-Related Concussion, Depression History, and Suicide Attempts in US Youth

JAMA Network Open, Год журнала: 2022, Номер 5(7), С. e2219934 - e2219934

Опубликована: Июль 1, 2022

Racial, ethnic, and sex disparities for concussion incidence suicide attempts in youth have been reported, but data on the interaction of these variables a large national set are lacking. Understanding how race ethnicity interact with to influence could yield critical information sociocultural impact brain injury mental health US youth.To examine associations history, ethnicity, reported among adolescents.This population-based cross-sectional cohort study used from Youth Risk Behavior Surveillance System (YRBSS) survey respondents between 2017 2019. Data were analyzed May 2021 January 2022.Respondents sport- or recreation-related (yes no), depression attempt no) over previous 12 months, along (categorized as American Indian Alaska Native, Asian, Black, Hispanic/Latino, multiracial, Native Hawaiian other Pacific Islander, White), (male female).Two Chi-Square Automatic Interaction Detection (CHAID) decision tree models built. The first was history (SA-DEP), second without (SA-NO DEP). CHAID uses risk factors (eg, number concussions, sex) divide sample into series subgroups that nested within each other. ratios (RRs) 95% CIs calculated subgroup provide effect estimates.A total 28 442 youths aged up 18 years (mean [SD] age, 14.6 [3.0] years; 14 411 [50.7%] female) responded survey. trees revealed complex race, sex, attempting suicide, which differed by (overall accuracy, 84.4%-97.9%). Overall, variable most strongly associated SA (adjusted odds ratio, 11.24; CI, 10.27-12.29). Concussion SA-DEP (RR, 1.31; 1.20-1.51; P < .001). multiracial increased compared others 1.59; 1.38-1.84; Hispanic/Latino SA-NO DEP 1.89; 1.54-2.32; .001) remaining population.These findings suggest clinicians should consider when evaluating role youth.

Язык: Английский

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An NLP approach to identify SDoH-related circumstance and suicide crisis from death investigation narratives

Journal of the American Medical Informatics Association, Год журнала: 2023, Номер 30(8), С. 1408 - 1417

Опубликована: Апрель 11, 2023

Abstract Objectives Suicide presents a major public health challenge worldwide, affecting people across the lifespan. While previous studies revealed strong associations between Social Determinants of Health (SDoH) and suicide deaths, existing evidence is limited by reliance on structured data. To resolve this, we aim to adapt suicide-specific SDoH ontology (Suicide-SDoHO) use natural language processing (NLP) effectively identify individual-level SDoH-related social risks from death investigation narratives. Materials Methods We used latest National Violent Death Report System (NVDRS), which contains 267 804 victim data 2003 2019. After adapting Suicide-SDoHO, developed transformer-based model circumstances crises in applied our retrospectively annotate narratives whose crisis variables were not coded NVDRS. The rates calculated as percentage group’s total population with present. Results Suicide-SDoHO 57 fine-grained hierarchical structure. Our classifier achieves AUCs 0.966 0.942 for classifying crises, respectively. Through trend analysis, observed that everyone equally affected risks. For economic stability crisis, result showed significant increase rate 2007–2009, parallel Great Recession. Conclusions This first study curating using showcased can classify through NLP approaches. hope will facilitate understanding inform effective prevention strategies.

Язык: Английский

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Is meeting with the 24-h movement recommendations linked with suicidality? Results from a nationwide sample of 44,734 U.S. adolescents

Journal of Affective Disorders, Год журнала: 2024, Номер 349, С. 617 - 624

Опубликована: Янв. 6, 2024

To our knowledge, only few studies have analyzed the relationship between meeting 24-h movement guidelines and suicidality in adolescents. The aim of this study was twofold: first, to examine association recommendations suicidal ideation, suicide planning, attempted a representative sample from U.S. adolescents; second, test whether age group, sex, or race moderate these associations. This is cross-sectional including pooled data 2011, 2013, 2015, 2017, 2019, 2021 high school Youth Risk Behavior Surveys (YRBS). A total 44,734 participants (48.5 % females) included. included physical activity, screen time, sleep duration. Suicidality examined considering three suicide-related behaviors: ideation (yes/no), planning (at least one time more during past 12 months). Adolescents who met all showed lower likelihood (odds ratio [OR] = 0.49, 95 confidence interval [CI] 0.37 0.63, p < 0.001), (OR CI 0.65, 0.67, 0.46 0.96, 0.038) than those did not meet recommendations. Overall, when younger adolescents, female adolescents minority races recommendations, they had risk outcomes not. using self-reported data. It possible establish cause-and-effect relationships, results could be influenced by some biases. suggests that play relevant role prevention suicide, nationwide

Язык: Английский

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