title: Identifying suicidal behavior among adolescents using administrative claims data.
abstract: OBJECTIVE
  To assess the safety of psychotropic medication use in children and adolescents, it is critical to be able to identify suicidal behaviors from medical claims data and distinguish them from other injuries. The purpose of this study was to develop an algorithm using administrative claims data to identify medically treated suicidal behavior in a cohort of children and adolescents.
  
  
  METHODS
  The cohort included 80,183 youth (6-18 years) enrolled in Tennessee's Medicaid program from 1995-2006 who were prescribed antidepressants. Potential episodes of suicidal behavior were identified using external cause-of-injury codes (E-codes) and ICD-9-CM codes corresponding to the potential mechanisms of or injuries resulting from suicidal behavior. For each identified episode, medical records were reviewed to determine if the injury was self-inflicted and if intent to die was explicitly stated or could be inferred.
  
  
  RESULTS
  Medical records were reviewed for 2676 episodes of potential self-harm identified through claims data. Among 1162 episodes that were classified as suicidal behavior, 1117 (96%) had a claim for suicide and self-inflicted injury, poisoning by drugs, or both. The positive predictive value of code groups to predict suicidal behavior ranged from 0-88% and improved when there was a concomitant hospitalization but with the limitation of excluding some episodes of confirmed suicidal behavior.
  
  
  CONCLUSIONS
  Nearly all episodes of confirmed suicidal behavior in this cohort of youth included an ICD-9-CM code for suicide or poisoning by drugs. An algorithm combining these ICD-9-CM codes and hospital stay greatly improved the positive predictive value for identifying medically treated suicidal behavior.
authors: Division of Adolescent and Young Adult Health, Department of Pediatrics, Vanderbilt School of Medicine, Nashville, Tennessee, USA. todd.callahan@vanderbilt.edu
authors: S Todd
authors: ST
authors: Callahan
authors: D Catherine
authors: DC
authors: Fuchs
authors: Richard C
authors: RC
authors: Shelton
authors: Leanne S
authors: LS
authors: Balmer
authors: Judith A
authors: JA
authors: Dudley
authors: Patricia S
authors: PS
authors: Gideon
authors: Michelle M
authors: MM
authors: Deranieri
authors: Shannon M
authors: SM
authors: Stratton
authors: Candice L
authors: CL
authors: Williams
authors: Wayne A
authors: WA
authors: Ray
authors: William O
authors: WO
authors: Cooper
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000187:drug effects*; D000367:Age Factors; D000465:Algorithms; D000928:Antidepressive Agents / Q000009:adverse effects*; D002648:Child; D057225:Data Mining; D016208:Databases, Factual / Q000706:statistics & numerical data*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D017723:Drug Utilization Review / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017891:Pharmacoepidemiology; D060735:Pharmacovigilance; D012189:Retrospective Studies; D012307:Risk Factors; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology*; D013997:Time Factors; D014481:United States
chemical_list: D000928:Antidepressive Agents
keywords: administrative claims; adolescence; pharmacoepidemiology; suicidal behavior