Psychiatric services utilization in completed suicides of a youth centres population.
BACKGROUND
From a retrospective study of youth centres (YCs) and coroner's files, we investigated youths' history of medical service utilization who died by suicide. This is the second of two papers on YCs population, the first paper having shown that the rate of psychopathology was higher in the YCs population compared to the general adolescent population.


METHODS
From 1995 to 2000, 422 youths, aged 18 years and younger, died as a result of suicide in Quebec. More than one-third received services from YCs at some point. Using the provincial physician payment and hospitalization database, we examined physical and psychiatric service utilization according to time intervals, as well as hospitalization for psychiatric reasons in the individuals' lifetime and in the year preceding suicide. Suicides were matched to living YCs youths for age, sex, and geographic area. YCs controls were then subdivided into two groups based on file information pertaining to the presence or absence of suicidal behavior or ideation.


RESULTS
Compared to living YCs youths, suicides had a higher rate of psychiatric service utilization in the week, month, 90 days, and year preceding suicide, as well as higher levels of lifetime hospitalization for psychiatric reasons than controls with or without a history of suicidal behavior or ideation. We found that 28.3% YCs suicides made use of psychiatric services in the year preceding suicide.


CONCLUSIONS
The rate of psychiatric service utilization by YCs youth suicides is substantially inferior to the needs of this population. Our study underscores the need for appropriate recognition of psychiatric and suicidal problems among YCs population by social and psycho-educational professionals. At the same time, it highlights the issues of general practitioners' risk identification, psychiatric referral and treatment. Our findings suggest the need for improved organization and coordination of psychiatric services to ameliorate treatment delivery.
Renaud
Johanne
J
Department of Child and Adolescent Psychiatry, CHU Mère-Enfant Sainte-Justine, 3175 Côte Sainte-Catherine, Université de Montréal, Montreal, Canada. johanne_renaud@ssss.gouv.qc.ca
Chagnon
François
F
Balan
Bogdan
B
Turecki
Gustavo
G
McGirr
Alexander
A
Marquette
Claude
C
D000293:Adolescent; D003156:Community Mental Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D003334:Coroners and Medical Examiners / Q000706:statistics & numerical data; D005194:Family Practice / Q000379:methods; D005260:Female; D006301:Health Services Needs and Demand; D006760:Hospitalization / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D020380:Needs Assessment; D011570:Psychiatry / Q000379:methods; D011792:Quebec / Q000453:epidemiology; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*