Effects of Geography on Risk for Future Suicidal Ideation and Attempts Among Children and Youth.
Effects of Geography on Risk for Future Suicidal Ideation and Attempts Among Children and Youth.
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DOI：
10.1016/j.jaacop.2023.07.002
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发表时间：
2023-11
期刊：
影响因子：
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通讯作者：
Pathak, Jyotishman
中科院分区：
文献类型：
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作者：
Xi, Wenna;Banerjee, Samprit;Zima, Bonnie T;Alexopoulos, George S;Olfson, Mark;Xiao, Yunyu;Pathak, Jyotishman
地理位置可能会影响儿童和青少年自杀意念（SI）和自杀企图（SA）的预测因素之间的关系。这是一项全国性的回顾性队列研究，研究对象为124，424名年龄小于25岁的个体，使用的是医疗保健成本研究所的商业索赔数据（2011-2015年）。结果是在索引精神健康或物质使用障碍（MH/SUD）门诊访视后3个月内至SI或SA的时间。预测因素包括索引事件发生前3年的社会人口统计学和临床特征。在每个随访时间段，SI和SA的发生率因美国地理分区而异（p < .001），山区分区的SI和SA发生率始终最高（SI为5.44%-10.26%; SA为0.70%-2.82%）。在过去的一年里，对于居住在新英格兰、大西洋中部、东北中部、西北中部和东南中部地区的个人来说，MH急诊科（艾德）就诊使SI的风险增加了28%至65%。地理分区的主效应对SA有显著影响（p<0.001）。SA的风险在新英格兰、中大西洋、南大西洋和太平洋地区较低（风险比分别为0.57、0.51、0.67和0.79），而在山区地区较高（风险比为1.46）。为了了解推动山区SI和SA高患病率的潜在机制以及MH艾德就诊后SI风险升高，未来研究SI和SA风险的区域差异应包括MH艾德护理和其他健康社会决定因素的指标。
Geography may influence the relationships of predictors for suicidal ideation (SI) and suicide attempts (SA) in children and youth. This is a nationwide retrospective cohort study of 124,424 individuals less than 25 years of age using commercial claims data (2011–2015) from the Health Care Cost Institute. Outcomes were time to SI or SA within 3 months after the indexed mental health or substance use disorder (MH/SUD) outpatient visit. Predictors included sociodemographic and clinical characteristics up to 3 years before the index event. At each follow-up time period, rates of SI and SA varied by the US geographic division (p < .001), and the Mountain Division consistently had the highest rates for both SI and SA (5.44%−10.26% for SI; 0.70%−2.82% for SA). Having MH emergency department (ED) visits in the past year increased the risk of SI by 28% to 65% for individuals residing in the New England, Mid-Atlantic, East North Central, West North Central, and East South Central Divisions. The main effects of geographic divisions were significant for SA (p<0.001). Risk of SA was lower in New England, Mid-Atlantic, South Atlantic, and Pacific (hazard ratios = 0.57, 0.51, 0.67, and 0.79, respectively) and higher in the Mountain Division (hazard ratio = 1.46). To understand the underlying mechanisms driving the high prevalence of SI and SA in the Mountain Division and the elevated risk of SI after having MH ED visits, future research examining regional differences in risks for SI and SA should include indicators of access to MH ED care and other social determinants of health.