Characterizing suicidal ideation, suicidal behaviors, and service utilization among unhoused individuals using a health information exchange.

Autor: Ho ZV; Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.; Center for Biomedical Informatics, Brown University, Providence, Rhode Island, USA., Arias SA; Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA.; Department of Psychosocial Research, Butler Hospital, Providence, Rhode Island, USA., Kunicki ZJ; Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.; Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA.; Department of Psychosocial Research, Butler Hospital, Providence, Rhode Island, USA., Sarkar IN; Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.; Center for Biomedical Informatics, Brown University, Providence, Rhode Island, USA.; Rhode Island Quality Institute, Providence, Rhode Island, USA., Chen ES; Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.; Center for Biomedical Informatics, Brown University, Providence, Rhode Island, USA.
Jazyk: angličtina
Zdroj: Journal of clinical psychology [J Clin Psychol] 2023 Nov; Vol. 79 (11), pp. 2542-2555. Date of Electronic Publication: 2023 Jul 11.
DOI: 10.1002/jclp.23566
Abstrakt: Introduction: Unhoused individuals have high rates of suicidal ideation (SI) and suicidal behaviors (SB), but few have studied the relative timing of homelessness and SI/SB. Our study examines the potential to use state-wide electronic health record data from Rhode Island's health information exchange (HIE) to identify temporal relationships, service utilization, and associations of SI/SB among unhoused individuals.
Methods: We use timestamped HIE data for 5368 unhoused patients to analyze service utilization and the relative timing of homelessness versus SI/SB onset. Multivariable models identified associations of SI/SB, hospitalization, and repeat acute care utilization within 30 days from clinical features representing 10,000+ diagnoses captured within the HIE.
Results: The onset of SI typically precedes homelessness onset, while the onset of SB typically follows. Weekly rates of suicide-related service utilization increased over 25 times the baseline rate during the week before and after homelessness onset. Over 50% of encounters involving SI/SB result in hospitalization. Of those engaging in acute care for suicide-related reasons, we found high rates of repeat acute care encounters.
Conclusion: HIEs are a particularly valuable resource for understudied populations. Our study demonstrates how longitudinal, multi-institutional data from an HIE can be used to characterize temporal associations, service utilization, and clinical associations of SI and behaviors among a vulnerable population at scale. Increasing access to services that address co-occurring SI/SB, mental health, and substance use is needed.
(© 2023 Wiley Periodicals LLC.)
Databáze: MEDLINE
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