Behavioral Health Service Utilization By Pediatric Military Dependents Following Diagnosis of a Suicide Attempt

Introduction: Little has been published to date regarding suicidal ideation and behaviors by pediatric military dependents, including prevalence, incidence, and health care service utilization. Given the 2017 focus of the Defense Health Board on identifying and improving inadequacies in health care services for military children, we are seeking to fill the knowledge gap on suicide-related behavioral health care for this population.

Understanding suicide is methodologically challenging given the low base rate of occurrence, which is further compounded when researchers focus on a subset of the population, such as pediatric patients. The current study addresses this issue by taking advantage of one of the largest systems of medical and billing data in the United States, the Defense Health Agency’s Military Health System Data Repository (MDR), which contains all Military Health System administrative medical records for more than ten million beneficiaries each year. The MDR links demographic information with inpatient and outpatient encounters that occur either in Military Treatment Facilities (MTFs) or in networks of purchased care.

Methods: This study will identify pediatric dependents (i.e., less than 18 years of age) in the MDR who were assigned an ICD-9 code for a suicide attempt from 2010 through 2015. A preliminary analysis identified more than 3,000 suicide attempt encounters for pediatric dependents each year, which accounts for 30-37% of all suicide attempt encounters among dependents. For these cases, we will examine demographic variables such as sex and age and military-related variables such as service branch and rank of the dependent’s TRICARE sponsor. In order to characterize the behavioral health care utilization following an initial suicide attempt diagnosis, we will examine the following variables: time to first behavioral health encounter following diagnosis; recorded diagnoses at index encounter (i.e., at first diagnosis of suicide attempt) and subsequent encounters; missed and cancelled appointments; number of and time from index encounter to subsequent hospitalization for a suicide attempt; total outpatient encounters in the twelve months following the index encounter; and type of provider for each encounter.

Conclusion: This presentation will educate audience members about behavioral health patterns of care for military pediatric patients diagnosed with suicide attempts. The dissemination of these findings to a large, diverse audience will generate conversation about pediatric aftercare and stimulate an increase in critical analyses of the healthcare needs of children who engage in suicide attempts in order to create more effective systems of care for children affected by a desire to die.