Treatment Utilization Before Suicide (TUBS)

描述（由申请人提供）：1999年至2010年期间，美国成人自杀率上升了近30%。几十年来，这些比率没有明显改善。迄今为止，自杀未遂和精神病诊断是自杀死亡的唯一已知临床风险因素。最近的研究表明，大多数死于自杀的人在死亡前的几周和几个月内进行了医疗保健访问。这些访问大多发生在初级保健或门诊医疗专业设置。然而，这些访问中有一半以上不包括精神病诊断。因此，可用的证据有限 美国普通人群中的医疗保健用户，以告知一般医疗环境中的有针对性的自杀筛查和风险识别工作。需要新的研究来调查与没有已知危险因素的个体中的自杀风险相关的一般医学临床因素。该研究项目使用了4000多名自杀死亡者的数据，这些人在死亡前一年曾前往美国八个医疗保健系统之一进行医疗保健访问。这些卫生系统是心理健康研究网络的成员，并有附属的卫生计划。他们能够为自己的孩子获得几乎所有的医疗保健服务。 虚拟数据仓库（Virtual Data Warehouse，VDW）VDW由使用跨站点的标准化数据结构和定义组织的电子医疗记录和保险索赔数据组成。这些数据与官方的区域死亡率数据相匹配。该项目包括以下具体目标：1）确定自杀前临床因素的类型和时间，2a） 比较自杀前的临床因素与健康护理使用者的匹配样本，2b）检测其他临床因素与自杀之间的关联，3）开发自杀前临床因素的预测模型，以及4）调查自杀前一般医疗图表笔记中隐藏的心理健康需求指标。我们采用病例对照研究方法来检验特定的假设，同时也使用新的环境范围内的关联研究方法和潜在类别分析来检测新的风险因素。我们开发了一个临床因素的预测模型， 和自杀我们使用定性分析来审查临床文本记录，并开发自然语言处理算法来识别风险。要研究的临床因素包括医学诊断、药物治疗、医疗保健程序和医疗保健访问的类型。这些结果将为如何在医疗环境中关注自杀预防的决策提供信息，并为2012年全国自杀预防行动联盟和美国外科医生总报告提供信息。

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.