Treatment Utilization Before Suicide (TUBS)

描述（由申请人提供）：1999年至2010年间，美国成年人的自杀率上升了近30%。几十年来，这些比率没有明显改善。迄今为止，以前的自杀企图和精神诊断在很大程度上是自杀死亡的唯一已知临床风险因素。最近的研究表明，大多数自杀身亡的人在死前几周和几个月去看了一次医生。这些访问大多发生在初级保健或门诊医疗专业设置。然而，超过一半的就诊不包括精神病诊断。因此，可获得的证据有限

DESCRIPTION (provided by applicant): Adult suicide rates in the United States rose by almost 30 percent between 1999 and 2010. These rates have not markedly improved in decades. To date, previous suicide attempts and psychiatric diagnoses are largely the only known clinical risk factors for suicide death. Recent research shows that most individuals who die by suicide make a health care visit in the weeks and months prior to their death. Most of these visits occur in primary care or outpatient medical specialty settings. However, over half of these visits do not include a psychiatric diagnosis. Thus, there is limited evidence available from health care users in the US general population to inform targeted suicide screening and risk identification efforts in general medical settings. New research is needed to investigate the general medical clinical factors associated with suicide risk among individuals without a known risk factor. This research project uses data on more than 4000 individuals who died by suicide and made health care visits to one of eight health care systems across the United States in the year prior to their death. These health systems are members of the Mental Health Research Network and have affiliated health plans. They are able to capture nearly all health care for their patients via the Virtual Data Warehouse (VDW). The VDW consists of electronic medical record and insurance claims data organized using standardized data structures and definitions across sites. These data are matched with official regional mortality data. This project includes the following Specific Aims: 1) Identify the types and timing of clinical factors prior to suicide, 2a) Compare clinical factors before suicide to a matched sample of health care users, 2b) Detect associations between additional clinical factors and suicide, 3) Develop a prediction model of clinical factors prior to suicide, and 4) investigate indicators of hidden mental health need in general medical chart notes prior to suicide. We employ a case-control study approach to test specific hypotheses, while also using novel environment-wide association study methods and latent class analysis to detect new risk factors. We develop a prediction model of clinical factors and suicide. We use qualitative analyses to review clinical text notes and develop a natural language processing algorithm to identify risk. Clinical factors to be studied include medical diagnoses, medications, health care procedures, and types of health care visits. These results will inform decisions about how to focus suicide prevention in medical settings and provide information in response to the 2012 National Action Alliance for Suicide Prevention and US Surgeon General report.