title: Service Use in the Month and Year Prior to Suicide Among Adults Enrolled in Ohio Medicaid.
abstract: OBJECTIVE
  The purpose of this study was to inform suicide prevention efforts by estimating the incidence of suicide among adult Medicaid enrollees and describing clinical profiles and service utilization patterns among decedents.
  
  
  METHODS
  Death certificate data for adults (N=1,338) ages 19 to 65 who died by suicide between January 1, 2008, and December 31, 2013, were linked with Ohio Medicaid data.
  
  
  RESULTS
  The suicide rate was 18.9 deaths per 100,000 Ohio Medicaid enrollees. Most decedents (83%) made a general medical or mental health visit within one year of suicide, with 50% doing so within 30 days and 27% within one week before death. In the year before suicide, the median number of visits was 16, indicating a subgroup with intensive service utilization. Decedents whose visits were proximal to suicide (within 30 days) rather than distal (31-365 days) were more likely to have individual and co-occurring behavioral and general medical conditions and to be Medicaid eligible through disability. In the year before suicide, most visits (79%) were outpatient general medical visits. Also in the year before suicide, decedents with serious psychiatric disorders were more likely than those without such disorders to make only mental health visits, and those with chronic general medical conditions were more likely than those without such conditions to make only general medical visits.
  
  
  CONCLUSIONS
  Medicaid enrollment designates a "virtual boundary" around a subpopulation of health care consumers relevant to national suicide prevention efforts. Findings highlight the potential of using Medicaid data to identify individuals at risk of suicide for screening, prevention, and intervention.
authors.affiliation: Dr. Fontanella is with the Department of Psychiatry and Behavioral Health, Wexner Medical Center, Ms. Hiance-Steelesmith is with the College of Social Work, and Dr. Campo is with the Department of Psychiatry, College of Medicine, all at Ohio State University, Columbus (e-mail: fontanella.4@osu.edu ). Dr. Warner is with the School of Social Welfare, University at Albany, Albany, New York. Ms. Sweeney is with the Ohio Department of Mental Health and Addiction Services, Columbus. Dr. Bridge is with the Research Institute at Nationwide Children's Hospital Pediatrics, Columbus. Dr. McKeon is with the Suicide Prevention Branch, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Fontanella
authors.affiliation: Dr. Fontanella is with the Department of Psychiatry and Behavioral Health, Wexner Medical Center, Ms. Hiance-Steelesmith is with the College of Social Work, and Dr. Campo is with the Department of Psychiatry, College of Medicine, all at Ohio State University, Columbus (e-mail: fontanella.4@osu.edu ). Dr. Warner is with the School of Social Welfare, University at Albany, Albany, New York. Ms. Sweeney is with the Ohio Department of Mental Health and Addiction Services, Columbus. Dr. Bridge is with the Research Institute at Nationwide Children's Hospital Pediatrics, Columbus. Dr. McKeon is with the Suicide Prevention Branch, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland.
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Warner
authors.affiliation: Dr. Fontanella is with the Department of Psychiatry and Behavioral Health, Wexner Medical Center, Ms. Hiance-Steelesmith is with the College of Social Work, and Dr. Campo is with the Department of Psychiatry, College of Medicine, all at Ohio State University, Columbus (e-mail: fontanella.4@osu.edu ). Dr. Warner is with the School of Social Welfare, University at Albany, Albany, New York. Ms. Sweeney is with the Ohio Department of Mental Health and Addiction Services, Columbus. Dr. Bridge is with the Research Institute at Nationwide Children's Hospital Pediatrics, Columbus. Dr. McKeon is with the Suicide Prevention Branch, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland.
authors.forename: Danielle L
authors.initials: DL
authors.lastname: Hiance-Steelesmith
authors.affiliation: Dr. Fontanella is with the Department of Psychiatry and Behavioral Health, Wexner Medical Center, Ms. Hiance-Steelesmith is with the College of Social Work, and Dr. Campo is with the Department of Psychiatry, College of Medicine, all at Ohio State University, Columbus (e-mail: fontanella.4@osu.edu ). Dr. Warner is with the School of Social Welfare, University at Albany, Albany, New York. Ms. Sweeney is with the Ohio Department of Mental Health and Addiction Services, Columbus. Dr. Bridge is with the Research Institute at Nationwide Children's Hospital Pediatrics, Columbus. Dr. McKeon is with the Suicide Prevention Branch, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland.
authors.forename: Helen Anne
authors.initials: HA
authors.lastname: Sweeney
authors.affiliation: Dr. Fontanella is with the Department of Psychiatry and Behavioral Health, Wexner Medical Center, Ms. Hiance-Steelesmith is with the College of Social Work, and Dr. Campo is with the Department of Psychiatry, College of Medicine, all at Ohio State University, Columbus (e-mail: fontanella.4@osu.edu ). Dr. Warner is with the School of Social Welfare, University at Albany, Albany, New York. Ms. Sweeney is with the Ohio Department of Mental Health and Addiction Services, Columbus. Dr. Bridge is with the Research Institute at Nationwide Children's Hospital Pediatrics, Columbus. Dr. McKeon is with the Suicide Prevention Branch, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bridge
authors.affiliation: Dr. Fontanella is with the Department of Psychiatry and Behavioral Health, Wexner Medical Center, Ms. Hiance-Steelesmith is with the College of Social Work, and Dr. Campo is with the Department of Psychiatry, College of Medicine, all at Ohio State University, Columbus (e-mail: fontanella.4@osu.edu ). Dr. Warner is with the School of Social Welfare, University at Albany, Albany, New York. Ms. Sweeney is with the Ohio Department of Mental Health and Addiction Services, Columbus. Dr. Bridge is with the Research Institute at Nationwide Children's Hospital Pediatrics, Columbus. Dr. McKeon is with the Suicide Prevention Branch, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland.
authors.forename: Richard
authors.initials: R
authors.lastname: McKeon
authors.affiliation: Dr. Fontanella is with the Department of Psychiatry and Behavioral Health, Wexner Medical Center, Ms. Hiance-Steelesmith is with the College of Social Work, and Dr. Campo is with the Department of Psychiatry, College of Medicine, all at Ohio State University, Columbus (e-mail: fontanella.4@osu.edu ). Dr. Warner is with the School of Social Welfare, University at Albany, Albany, New York. Ms. Sweeney is with the Ohio Department of Mental Health and Addiction Services, Columbus. Dr. Bridge is with the Research Institute at Nationwide Children's Hospital Pediatrics, Columbus. Dr. McKeon is with the Suicide Prevention Branch, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland.
authors.forename: John V
authors.initials: JV
authors.lastname: Campo
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D009820:Ohio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D013405:Suicide / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States; D055815:Young Adult
keywords: Medicaid; Suicide decedents; service utilization