Suicidal Behavior and Non-Suicidal Self-Injury in Emergency Departments Underestimated by Administrative Claims Data

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 318-325 ◽  
Author(s):  
Barbara Stanley ◽  
Glenn W. Currier ◽  
Megan Chesin ◽  
Sadia Chaudhury ◽  
Shari Jager-Hyman ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Suicide Attempts ◽  
The United States ◽  
Administrative Claims ◽  
Suicide Attempters ◽  
Self Injury ◽  
Axis I ◽  
Ed Visits ◽  
External Causes ◽  
Severe Psychopathology

Abstract. Background: External causes of injury codes (E-codes) are used in administrative and claims databases for billing and often employed to estimate the number of self-injury visits to emergency departments (EDs). Aims: This study assessed the accuracy of E-codes using standardized, independently administered research assessments at the time of ED visits. Method: We recruited 254 patients at three psychiatric emergency departments in the United States between 2007 and 2011, who completed research assessments after presenting for suicide-related concerns and were classified as suicide attempters (50.4%, n = 128), nonsuicidal self-injurers (11.8%, n = 30), psychiatric controls (29.9%, n = 76), or interrupted suicide attempters (7.8%, n = 20). These classifications were compared with their E-code classifications. Results: Of the participants, 21.7% (55/254) received an E-code. In all, 36.7% of research-classified suicide attempters and 26.7% of research-classified nonsuicidal self-injurers received self-inflicted injury E-codes. Those who did not receive an E-code but should have based on the research assessments had more severe psychopathology, more Axis I diagnoses, more suicide attempts, and greater suicidal ideation. Limitations: The sample came from three large academic medical centers and these findings may not be generalizable to all EDs. Conclusion: The frequency of ED visits for self-inflicted injury is much greater than current figures indicate and should be increased threefold.

Trends in US Emergency Department Visits for Suicide Attempts, 1992–2001

Crisis ◽  
2008 ◽  
Vol 29 (2) ◽  
pp. 73-80 ◽  
Author(s):  
Gregory Luke Larkin ◽  
Rebecca P. Smith ◽  
Annette L. Beautrais
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Suicide Attempt ◽  
Emergency Departments ◽  
Urban Areas ◽  
Suicide Attempts ◽  
The United States ◽  
Emergency Department Visits ◽  
Health Related ◽  
Ed Visits

This article describes trends in suicide attempt visits to emergency departments in the United States (US). Data were obtained from the National Hospital Ambulatory Medical Care Survey using mental-health-related ICD-9-CM, E and V codes, and mental-health reasons for visit. From 1992 to 2001, mental-health-related visits increased 27.5% from 17.1 to 23.6 per 1000 (p < .001). Emergency Department (ED) visits for suicide attempt and self injury increased by 47%, from 0.8 to 1.5 visits per 1000 US population (ptrend = .04). Suicide-attempt-related visits increased significantly among males over the decade and among females from 1992/1993 to 1998/1999. Suicide attempt visits increased in non-Hispanic whites, patients under 15 years or those between 50–69 years of age, and the privately insured. Hospitalization rates for suicide attempt-related ED visits declined from 49% to 32% between 1992 and 2001 (p = .04). Suicide attempt-related visits increased significantly in urban areas, but in rural areas suicide attempt visits stayed relatively constant, despite significant rural decreases in mental-health related visits overall. Ten-year regional increases in suicide attempt-related visits were significant for the West and Northeast only. US emergency departments have witnessed increasing rates of ED visits for suicide attempts during a decade of significant reciprocal decreases in postattempt hospitalization. Emergency departments are increasingly important sites for identifying, assessing and treating individuals with suicidal behavior.

scholarly journals Study of Life Stressors and Suicidal Intent of Suicidal Attempters with or Without Axis 1 Psychiatric Comorbidities: A Case Control Study

2017 ◽  
Vol 4 (4) ◽  
Author(s):  
Sivabalan E ◽  
Arun Narayan Pradeep
Keyword(s):  
Psychiatric Disorders ◽  
Case Control Study ◽  
Suicide Attempts ◽  
Case Control ◽  
Life Stressors ◽  
Suicide Attempters ◽  
Suicidal Intent ◽  
Axis I Disorders ◽  
Axis I ◽  
Control Study

Background: Suicide attempts and Psychiatric illness are interrelated in a complex and bi directional way such that either of them leaves an impact on the other. People with Psychiatric morbidity are at high risk of attempting suicide. Even though extensive research works have been done in suicide, there is a paucity of studies focusing the mentally ill attempters, especially with reference to Intent and Lethality. Hence the present study designed to study the various parameters , contributing factors and Risk factors associated with suicide attempts of patient with Axis I disorders. Aim: 1.To assess the life stressors and suicidal intent in suicide attempters with Axis I psychiatric disorders. 2. To assess the life stressors and suicidal intent in suicide attempters without Axis I psychiatric disorders. 3. Compare the life stressors and suicidal intent in suicide attempters with and without axis I disorders. Material and Methods: The study subjects of this case control study were recruited from the patients referred to the department of Psychiatry from Medicine, Surgical and Intensive care wards for Psychiatric evaluation.30 patients of attempted suicide who had Axis I diagnosis as per the ICD – 10 criteria were taken as cases and 30 age and sex matched patients were taken as controls. Results: 1.The suicidal intent is high in Suicide attempters with Axis I Disorders. 2. The lethality is high in Suicidal attempters with Axis I Disorders. 3. Stress factors play a major role in Suicide attempters with Axis I disorders.

scholarly journals Mental Health Costs of Inflammatory Bowel Diseases

2020 ◽  
Vol 27 (1) ◽  
pp. 40-48 ◽  
Author(s):  
Eva Szigethy ◽  
Sean M Murphy ◽  
Orna G Ehrlich ◽  
Nicole M Engel-Nitz ◽  
Caren A Heller ◽  
...  
Keyword(s):  
Mental Health ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Claims Data ◽  
The United States ◽  
Cost Of Care ◽  
Medical Utilization ◽  
Administrative Claims ◽  
Inflammatory Bowel ◽  
Ed Visits

Abstract Background Mental health diagnoses (MHDs) were identified as significant drivers of inflammatory bowel disease (IBD)-related costs in an analysis titled “Cost of Care Initiative” supported by the Crohn’s & Colitis Foundation. In this subanalysis, we sought to characterize and compare IBD patients with and without MHDs based on insurance claims data in terms of demographic traits, medical utilization, and annualized costs of care. Methods We analyzed the Optum Research Database of administrative claims from years 2007 to 2016 representing commercially insured and Medicare Advantage insured IBD patients in the United States. Inflammatory bowel disease patients with and without an MHD were compared in terms of demographics (age, gender, race), insurance type, IBD-related medical utilization (ambulatory visits, emergency department [ED] visits, and inpatient hospitalizations), and total IBD-related costs. Only patients with costs &gt;$0 in each of the utilization categories were included in the cost estimates. Results Of the total IBD study cohort of 52,782 patients representing 179,314 person-years of data, 22,483 (42.6%) patients had at least 1 MHD coded in their claims data with a total of 46,510 person-years in which a patient had a coded MHD. The most commonly coded diagnostic categories were depressive disorders, anxiety disorders, adjustment disorders, substance use disorders, and bipolar and related disorders. Compared with patients without an MHD, a significantly greater percentage of IBD patients with MHDs were female (61.59% vs 48.63%), older than 75 years of age (9.59% vs 6.32%), white (73.80% vs 70.17%), and significantly less likely to be younger than 25 years of age (9.18% vs 11.39%) compared with those without mental illness (P &lt; 0.001). Patients with MHDs had significantly more ED visits (14.34% vs 7.62%, P &lt; 0.001) and inpatient stays (19.65% vs 8.63%, P &lt; 0.001) compared with those without an MHD. Concomitantly, patients with MHDs had significantly higher ED costs ($970 vs $754, P &lt; 0.001) and inpatient costs ($39,205 vs $29,550, P &lt; 0.001) compared with IBD patients without MHDs. Patients with MHDs also had significantly higher total annual IBD-related surgical costs ($55,693 vs $40,486, P &lt; 0.001) and nonsurgical costs (medical and pharmacy) ($17,220 vs $11,073, P &lt; 0.001), and paid a larger portion of the total out-of-pocket cost for IBD services ($1017 vs $905, P &lt; 0.001). Conclusion Patients whose claims data contained both IBD-related and MHD-related diagnoses generated significantly higher costs compared with IBD patients without an MHD diagnosis. Based on these data, we speculate that health care costs might be reduced and the course of patients IBD might be improved if the IBD-treating provider recognized this link and implemented effective behavioral health screening and intervention as soon as an MHD was suspected during management of IBD patients. Studies investigating best screening and intervention strategies for MHDs are needed.

Prevalence of subthreshold forms of psychiatric disorders in persons making suicide attempts in Hungary

2000 ◽  
Vol 15 (6) ◽  
pp. 354-361 ◽  
Author(s):  
J. Balázs ◽  
I. Bitter ◽  
Y. Lecrubier ◽  
N Csiszér ◽  
G. Ostorharics
Keyword(s):  
Psychiatric Disorders ◽  
Suicide Attempts ◽  
Structured Interview ◽  
Background Information ◽  
Semistructured Interview ◽  
Suicide Attempters ◽  
Psychiatric Illnesses ◽  
Current Threshold ◽  
Axis I ◽  
Dsm Iv

summaryBackground – Suicide and suicide attempts have been associated to psychiatric illnesses; however, little is known about the role in suicide risk of those symptoms that do not meet the full criteria for a DSM-IV disorder. The aim of this study was to examine the prevalence of subthreshold psychiatric disorders among suicide attempters in Hungary. Methods – Using a modified structured interview (Mini International Neuropsychiatric Interview) determining 16 Axis I psychiatric diagnoses and their subthreshold forms defined by the DSM-IV and a semistructured interview collecting background information, the authors examined 140 consecutive suicide attempters, aged 18–65 years. Results – Eighty-three-point-six percent of the attempters had one or more current threshold diagnoses on Axis I and in addition more than three-quarters (78.6%) of the subjects had at least one subthreshold diagnosis. Six-point-four percent of the subjects (N = 9) had neither subthreshold nor threshold diagnoses at the time of their suicide attempts. Ten percent of the subjects (N = 14), not meeting the full criteria for any DSM-IV diagnoses, had at least one subthreshold diagnosis. In 68.6% of the subjects (N = 96), both subthreshold and threshold disorders were diagnosed at the time of their suicide attempts. The number of subthreshold and threshold diagnoses were positively and significantly related (χ2 = 5.12, df = 1, P < 0.05). Sixty-three-point-six percent of the individuals received two or more current threshold diagnoses on Axis I and 44.3% of the individuals (N = 62) had two or more subthreshold diagnoses at the time of their suicide attempts. Limitations – The subthreshold definitions in this study included only those forms of the disorders which required the same duration as the criteria DSM-IV disorder with fewer symptoms. Conclusions – Suicide attempts showed a very high prevalence of subthreshold disorders besides psychiatric disorders meeting the full criteria required according to the DSM-IV. Subthreshold forms of mental disorders need to be taken into account in suicide prevention.

Hundred psychiatric outpatients presented with attempted suicide

1970 ◽  
Vol 9 (3) ◽  
pp. 162-167 ◽  
Author(s):  
N Sapkota ◽  
AK Pandey ◽  
PM Shyangwa ◽  
DR Shakya ◽  
DK Thapa
Keyword(s):  
Rural Areas ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Interpersonal Conflict ◽  
The United States ◽  
Cross Sectional Study ◽  
Demographic Variables ◽  
Health Concern ◽  
Cross Sectional ◽  
Suicide Attempters

Introduction: Suicide is a major public health concern and it is one of the commonest Psychiatric emergencies. Suicide rates are increasing and have become a global concern with more than 600,000 suicidal attempts every year in the United States, alone. There is no national data available for Nepal. This hospital based study may help in understanding about the cause and methods of suicide attempts. Objective: The aim of the present study was to assess the (i) methods and precipitating cause for attempted suicide (ii) to study the relationship between major socio-demographic variables and attempted suicide. This study may be helpful in formulating suicide prevention strategies at different levels. Methods: Cross-sectional study in a tertiary level hospital. Consecutive 100 cases of attempted suicide coming in contact to an investigating team were evaluated for methods opted for attempting suicide and underlying cause was explored. Demographic variables were recorded and analysed. Results: Majority of the suicide attempters (67%) were less than 35 years of age, and female outnumbered male. Sixty one percent of the subject belonged to rural background. Out of 100 suicide attempters 40% of them have completed SLC and majority of them were students. Fifty-four percent of the sample consumed pesticides and 25% of the cases used highly lethal means. Majority of the persons (58%) had psychiatric co morbidities in which depression was the commonest. Interpersonal conflict accounted for 18% of the cases followed by marital problems (13%) as triggering factors of attempted suicide. Conclusion: Majority of the suicide attempters were young and having psychiatric disorders. Most of the attempters were from rural areas. Keywords: Attempted suicide; psychiatric co morbidities; Interpersonal conflict. DOI: http://dx.doi.org/10.3126/hren.v9i3.5584   HR 2011; 9(3): 162-167

Abstract WP228: Reversible Cerebral Vasoconstriction Syndrome: Presenting Symptoms, Incidence, and Outcomes in a Multi-State Cohort in the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jessica Magid-Bernstein ◽  
Setareh Salehi Omran ◽  
Santosh B Murthy ◽  
Alexander E Merkler ◽  
Hooman Kamel
Keyword(s):  
Validation Study ◽  
The United States ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Administrative Claims ◽  
Diagnosis Code ◽  
Presenting Symptoms ◽  
Cerebral Vasoconstriction ◽  
Icd 10 ◽  
Ed Visits ◽  
The U.S

Introduction: Reversible cerebral vasoconstriction syndrome (RCVS) is a syndrome of recurrent thunderclap headaches with transient cerebral vasoconstriction which can cause stroke. There are few population-based data on the incidence of RCVS as well as associated risk factors and complications. Methods: We performed a retrospective cohort study using administrative claims data from all nonfederal emergency department (ED) visits and hospitalizations in 11 U.S. states during 2016. Using ICD-10 diagnosis code I67.841, we identified adult patients hospitalized with RCVS and evaluated associated diagnoses during prior, concurrent, and subsequent ED visits and hospitalizations. We used U.S. census data to estimate the age- and sex-standardized incidence of RCVS in the U.S. adult population. In a validation study, we reviewed the records of patients with a discharge diagnosis of RCVS and a random sample of patients with other cerebrovascular diagnoses at our medical center to estimate the sensitivity and specificity of the RCVS diagnosis code, and calculated the RCVS 2 score of patients with RCVS. Results: In our validation study, the sensitivity of the RCVS ICD-10 code was 100% (95% CI, 66-100%) and the specificity 90% (95% CI, 74-98%); the median RCVS 2 score among patients diagnosed with RCVS was 6, supporting that the diagnosis code generally identified true cases of RCVS. In our statewide analysis, we identified 222 patients diagnosed with RCVS in 2016, equating to a U.S. incidence of 2.7 (95% CI, 2.4-3.1) per million adults per year. The mean age was 46.8 (±14.3) years, 63.5% of patients were white, and 77.5% were female. There were 17 ED visits (22% of all ED visits) for headache in the 3 months before RCVS diagnosis. During the RCVS hospitalization, the most common complications were subarachnoid hemorrhage (33.5%), followed by ischemic stroke (14.9%), intracerebral hemorrhage (9.3%), and seizures (9.3%). Most patients were discharged home after admission for RCVS (76.6%). Conclusions: Hospitalization with a recognized case of RCVS occurs in about 3 per million adults in the U.S. per year. Although majority of patients hospitalized with RCVS were discharged home, a substantial proportion had serious cerebrovascular complications.

scholarly journals Normal Metabolic Levels in Prefrontal Cortex in Euthymic Bipolar I Patients with and without Suicide Attempts

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Marlos Vasconcelos Rocha ◽  
Fabiana Nery-Fernandes ◽  
José Luiz Guimarães ◽  
Lucas de Castro Quarantini ◽  
Irismar Reis de Oliveira ◽  
...  
Keyword(s):  
Prefrontal Cortex ◽  
Healthy Subjects ◽  
Rating Scale ◽  
Suicide Attempts ◽  
Resonance Spectroscopy ◽  
Type I ◽  
Young Mania ◽  
Suicide Attempters ◽  
Axis I ◽  
Bipolar Patients

Introduction/Objective. Evidence suggests that the prefrontal cortex has been implicated in the pathophysiology of bipolar disorder (BD), but few neurochemical studies have evaluated this region in bipolar patients and there is no information from BD suicide attempters using Proton Magnetic Resonance Spectroscopy (H+MRS). The objective was to evaluate the metabolic function of the medial orbital frontal cortex in euthymic BD type I suicide and nonsuicide attempters compared to healthy subjects by H+MRS.Methods. 40 euthymic bipolar I outpatients, 19 without and 21 with history of suicide attempt, and 22 healthy subjects were interviewed using the Structured Clinical Interview with the DSM-IV axis I, the Hamilton Depression Rating Scale, the Young Mania Rating Scale, and the Barratt Impulsiveness Scale-11 and underwent H+MRS.Results. We did not find any metabolic abnormality in medial orbital frontal regions of suicide and nonsuicide BD patients and BD patients as a group compared to healthy subjects.Conclusions. The combined chronic use of psychotropic drugs with neuroprotective or neurotrophic effects leading to a euthymic state for longer periods of time may improve neurometabolic function, at least measured by H+MRS, even in suicide attempters. Besides, these results may implicate mood dependent alterations in brain metabolic activity. However, more studies with larger sample sizes of this heterogeneous disorder are warranted to clarify these data.

Trends in the Evaluation and Management of Back Pain in Emergency Departments, United States, 2007–2016

Pain Medicine ◽  
2020 ◽  
Author(s):  
Peter M Mullins ◽  
John Gates Merriman ◽  
Todd A Jaffe ◽  
Maryann Mazer-Amirshahi ◽  
Scott G Weiner
Keyword(s):  
United States ◽  
Back Pain ◽  
Emergency Departments ◽  
Optimal Strategies ◽  
The United States ◽  
Admission Rates ◽  
Annual Survey ◽  
Imaging Utilization ◽  
Ed Visits ◽  
Nationally Representative

Abstract Objective  Back pain is one of the most common pain syndromes in the United States, but there has been limited recent description of the role of emergency departments (EDs) in caring for patients with back pain. We investigated trends in the evaluation and management of back pain in U.S. EDs from 2007 to 2016. Methods  We performed a retrospective analysis of the National Hospital Ambulatory Medical Care Survey, a nationally representative annual survey of ED visits, which includes data on patient-, hospital-, and visit-level characteristics. We evaluated trends among adult ED visits for back pain, including demographics, resource utilization, and disposition. Trends were assessed through the use of survey-weighted analyses. Results  Visit rates as a proportion of overall ED visits were stable from 2007 to 2016 (9.1% [95% confidence interval (CI): 8.5–9.6] vs. 9.3% [95% CI: 8.6–10.0]; P = 0.44). Admission rates declined from 6.4% (95% CI: 5.1–8.0) to 5.0% (95% CI: 3.5–6.9; P &lt; 0.001). Imaging utilization increased from 51.7% (95% CI: 49.3–54.1) to 57.6% (95% CI: 53.3–61.7; P = 0.023), with an increase of 58.3% in computed tomography. Overall opioid utilization declined from 53.5% (95% CI: 49.4–57.5) to 46.5% (95% CI: 43.2–49.8; P &lt; 0.001). Tramadol use increased over the study period (4.1% [95% CI: 3.0–5.8] vs. 8.4% [95% CI: 6.6–10.7]; P &lt; 0.001). Conclusions  Opioid utilization during ED visits for back pain decreased from 2007 to 2016, whereas tramadol use more than doubled. Care intensity increased significantly despite declining admission rates. Further research into optimal strategies for back pain management in the ED is needed.

The Heterogeneity of Suicide Attempters: An Analysis of Single- and Repeat-Suicide Attempters Among People in Custody

2020 ◽  
pp. 009385482098385
Author(s):  
Bryce E. Stoliker
Keyword(s):  
United States ◽  
Representative Sample ◽  
Suicide Attempts ◽  
The United States ◽  
Risk Profile ◽  
Cross Sectional ◽  
Suicide Attempters ◽  
Men And Women ◽  
Similarities And Differences ◽  
Nationally Representative

Suicide attempters represent a heterogeneous group, whereby repeat-suicide attempters possess a differing risk profile compared with single-suicide attempters. Using cross-sectional data from a nationally representative sample of 18,185 people in custody in the United States, the current study compared repeat-suicide attempters ( n = 1,549) to single-suicide attempters ( n = 1,146), and compared single- and repeat-suicide attempters to suicide ideators ( n = 1,741), on a range of correlates. Multiple suicide attempts were more commonly reported than a single attempt, especially among women. Several factors differentiated repeat-suicide attempters from single-suicide attempters, with men and women exhibiting some similarities and differences in correlates of repeat- versus single-suicide attempts. Several factors also differentiated single- and repeat-suicide attempters from suicide ideators. Overall, repeat-suicide attempters exhibited greater vulnerability to respond to stress through means of suicide as compared with single-suicide attempters. Discussion emphasizes the importance of acknowledging the heterogeneity of suicide attempters.

Characteristics of the schizophrenia suicide attempts in comparison with the suicide attempts with other diagnosed psychiatric disorders: An Egyptian study

2019 ◽  
Vol 65 (5) ◽  
pp. 368-377 ◽  
Author(s):  
Mai SeifElDin Abdeen ◽  
Nermin Mahmoud Shaker ◽  
Hanan Hany Elrassas ◽  
Mostafa Ahmad Hashim ◽  
Mohamed Youssef Abo Zeid
Keyword(s):  
Psychiatric Disorders ◽  
Suicide Attempts ◽  
Past History ◽  
Clinical Interview ◽  
Suicide Attempters ◽  
Schizophrenia Group ◽  
Suicide Probability Scale ◽  
Axis I ◽  
Dsm Iv ◽  
Characteristic Features

Background: There has been much literature on schizophrenia, but little is known about the characteristic features of suicide attempts with schizophrenia in comparison with the suicide attempts with other diagnosed psychiatric disorders. Aims: The objective of this study was to clarify the specific characteristics and risk factors among suicide attempters with schizophrenia that differentiate them from other psychiatric disorders. Methods: Thirty-three suicide attempters diagnosed with schizophrenia and 87 suicide attempters with other psychiatric disorders were included. Suicide attempts seriousness were appraised by the Beck’s Suicide Intent Scale (BSIS). Standardized scales were applied: Suicide Probability Scale (SPS) and Barratt Impulsiveness Scale, Version 11 (BIS-11). The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and The Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) based on the Diagnostic and Statistical Manual of Mental Disorders-IV ( DSM-IV) was applied to assess the psychiatric status of individuals. Demographic and clinical characteristics, method of suicide and suicide probability scores and impulsivity were compared among both groups (schizophrenia group and other psychiatric disorders group). Results: In total, 27.5% of suicide attempts suffered from schizophrenia. The current study found that having more past history of medical diseases, longer duration of illness, using more violent suicidal methods, and having less significant suicidal ideations were the significant factors that differentiated schizophrenia suicide attempts from those diagnosed with other psychiatric disorders. The schizophrenia group did not show more impulsivity or hostility than other psychiatric disorders group. Conclusion: These results indicated that each group shows its unique characteristics. They give us new perspectives to prevent suicides in schizophrenia according to their different characteristics.

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