Timely follow-up reduces suicide risk for youths discharged from psychiatric hospital
Youths who received outpatient mental health follow-up within 1 week of psychiatric hospital discharge appeared at reduced risk for suicide in the immediate period after discharge, according to study results published in JAMA Network Open.
“Although quality of care measures including 7- and 30-day follow-ups are common, little empirical research has established whether these metrics are associated with positive outcomes, such as reduced suicides,” Cynthia A. Fontanella, PhD, associate professor of the department of psychiatry and behavioral health at Ohio State University Wexner Medical Center, told Healio Psychiatry. “This study was meant to help fill in this gap. Timely follow-up care is critical to ensure continuity of care and positive outcomes (e.g., reduced suicide) for youths with psychiatric hospitalizations.”
Results of a prior study suggested that only approximately half of psychiatric inpatients in the U.S. receive outpatient mental health care in the week following discharge and approximately two-thirds receive care within 1 month. Other research showed potential associations between follow-up within 7 days of hospital discharge and demographic characteristics, including race/ethnicity and age, as well as clinical factors.
In the current population-based, retrospective, longitudinal cohort study, Fontanella and colleagues sought to determine whether receiving outpatient care within 7 days of discharge from a psychiatric hospital was linked to reduced risk for subsequent suicide among child and adolescent inpatients, as well as to evaluate factors related to timely follow-up care. They analyzed Medicaid data from 33 states linked with National Death Index data of all 139,694 youths aged 10 to 18 years who were admitted to a psychiatric hospital between January 2009 and December 2013. Mental health follow-up visits received within 7 days of discharge from the psychiatric hospital served as the exposure. Suicides that occurred in the 8 to 180 days following hospital discharge served as the main outcome. The researchers used logistic regression to model the association between demographic, clinical and mental health service history factors and outpatient visit receipt within 7 days of discharge.
Results showed 56.5% of the patients received a mental health follow-up visit within 7 days of discharge. Visits were associated with a significantly lower risk for suicide (adjusted relative risk = 0.44; 95% CI, 0.23-0.83) during the period studied after discharge. Those who had longer lengths of stay, prior outpatient mental health care and foster care placement more often received 7-day follow-up. Those who were non-Hispanic Black, older, medically ill and had managed care insurance less frequently received follow-up visits.
“Youth being discharged from psychiatric hospitalizations need to be seen in outpatient settings quickly for continuity of care,” Fontanella told Healio Psychiatry. “Black and other minority youth were less likely to receive follow-up care than white youth, highlighting racial and ethnic disparities in receipt of care. Older adolescents were also less likely than younger adolescents to receive timely follow-up care. Quality improvement efforts can address these disparities, perhaps by developing and testing culturally and demographically tailored interventions to enhance continuity of care.”
In a related editorial, David A. Brent, MD, of the department of psychiatry at University of Pittsburgh School of Medicine, and colleagues highlighted the importance of addressing the disparities brought to light in this study.
“The goal of such research is not merely to document the sources of disparities but to devise actionable interventions and policies that bridge these gaps in care,” they wrote. “We need to label these disparities as what they are: unacceptable. Just as we must address the gaps that occur between transitions in care, we must also bridge gaps that are defined by race, ethnicity and class, so that all people receive the care that they need and deserve. In so doing, we can reverse the disturbing upward trend in suicide in U.S. youth in general, and in Black youth in particular.”