Association of Timely Outpatient Mental Health Services for Youths After Psychiatric Hospitalization With Risk of Death by Suicide [2020]

Question Is receipt of mental health follow-up visits within 7 days of hospital discharge associated with risk of suicide among child and adolescent inpatients, and what factors are associated with receipt of timely follow-up care?

Findings In this cohort study of 139 694 child and adolescent inpatients in the Medicaid program, mental health follow-up received within 7 days of discharge was associated with a reduced risk of suicide during the 8 to 180 days after hospital discharge. Shorter hospital stay, lack of prior mental health care, managed care, Black race, older age, and medical comorbidities were associated with delayed follow-up care.

Meaning Outpatient mental health follow-up within 7 days of psychiatric hospital discharge may be associated with a reduced risk of suicide among children and adolescents in the immediate postdischarge period.

Abstract
Importance Timely outpatient follow-up care after psychiatric hospitalization is an established mental health quality indicator and considered an important component of suicide prevention, yet little is known about whether follow-up care is associated with a reduced risk of suicide soon after hospital discharge.

Objective To evaluate whether receipt of outpatient care within 7 days of psychiatric hospital discharge is associated with a reduced risk of subsequent suicide among child and adolescent inpatients and examine factors associated with timely follow-up care.

Design, Setting, and Participants This population-based, retrospective, longitudinal cohort study used Medicaid data from 33 states linked with National Death Index data. The study population included all youths aged 10 to 18 years who were admitted to a psychiatric hospital from January 1, 2009, to December 31, 2013. Data analysis was completed from October 9, 2019, through May 15, 2020.

Exposure Mental health follow-up visits received within 7 days of hospital discharge.

Main Outcomes and Measures Suicides occurring in the 8 to 180 days after hospital discharge. Logistic regression modeled the association between demographic, clinical, and mental health service history factors and receipt of an outpatient visit within 7 days after discharge. Poisson regression estimated the association between suicide risk and outpatient visits within 7 days after discharge, adjusting for confounding using inverse probability of treatment weights from the logistic model.

Results Of the total 139 694 youths admitted to a psychiatric hospital, 51.9% were female, 31.1% were aged 10 to 13 years, and 68.9% were aged 14 to 18 years. A total of 56.5% of the youths received a mental health follow-up visit within 7 days of discharge, and this was associated with a significantly lower odds of suicide (adjusted relative risk, 0.44; 95% CI, 0.23-0.83; P = .01) during the 8 to 180 days postdischarge period. Youths with longer lengths of stay (4-5 days: adjusted odds ratio [AOR], 1.20 [95% CI, 1.17-1.24]; 6-7 days: AOR, 1.47 [95% CI, 1.43-1.52]; 8-12 days AOR, 1.75 [95% CI, 1.69-1.81]; 13-30 days: AOR, 1.71 [95% CI, 1.63-1.78]), prior outpatient mental health care (AOR, 1.58; 95% CI, 1.51-1.65), and foster care placement (AOR, 1.32; 95% CI, 1.28-1.37) were more likely to receive 7-day follow-up, whereas those who were non-Hispanic Black (AOR, 0.82; 95% CI, 0.79-0.84), were older (AOR, 0.82; 95% CI, 0.80-0.84), were medically ill (AOR, 0.77; 95% CI, 0.74-0.81), and had managed care insurance (AOR, 0.88; 95% CI, 0.87-0.91) were less likely to receive follow-up visits.

Conclusions and Relevance In this cohort study, risk of suicide during the 6 months after psychiatric hospitalization was decreased among youth who had an outpatient mental health visit within 7 days after discharge. Addressing disparities in timely continuity of care may help advance health equity agendas.

Cynthia A. Fontanella, PhD; Lynn A. Warner, PhD; Danielle L. Steelesmith, PhD; Guy Brock, PhD; Jeffrey A. Bridge, PhD; John V. Campo, MD
JAMA Network Open, August 11, 2020
DOI: 10.1001/jamanetworkopen.2020.12887
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