More Accurate Detection of Self-Destructive Behaviors in Minoritized Youth is Needed

On By Karl

More accurate identification self-destructive thoughts and behaviors (SITB) can provide more fair care strives to prevent youth suicide. According to a study published today JAMA Network Openkey concerns and diagnostic codes have harmed minority youth experiencing suicide emergencies, reinforcing the need to combat algorithmic biases, develop suicide prevention strategies, and better assess the needs of youth in these situations.1

Suicide is the biggest cause of death in young people | Image Credit: © Cavan – Stock.adobe.com

Currently, data Mental Health America It shows that more than 13% of U.S. youth (n = 3.4 million) have experienced serious suicidal thoughts, and more than 20% have experienced one or more major depressive episodes in the past year. These figures demonstrate the seriousness of mental health (MH) issues in today’s youth that require greater attention.

According to databases, more than 50% of youth with major depression have not received MH treatment from a medical professional, counselor, or other MH provider; This is largely because they think they have to handle the OD themselves or because they don’t know how or where it happens. to find treatment. Additionally, young people state that they fear the stigma of MH and the possibility that their information will not be kept confidential.2 The authors of this article point out that suicide is the most common cause of death affecting the young population; Combined with these statistics from Mental Health America, it becomes clear how serious and overlooked MH issues can be for those struggling.1

To assess the state of SITB detection methods, researchers conducted a retrospective, cross-sectional study to evaluate electronic medical records (EMRs) from emergency department (ED) visits at a large Southern California healthcare system. They also analyzed how the system’s algorithms performed across varying demographic groups. Individuals ages 6 to 17 years admitted with at least 1 MH-related emergency department visit from October 2017 to 2019 were included. International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code was used to identify SITB, and case surveillance (CS based only on the primary concern and codes) and adjusted CS (aCS that takes into account additional features such as medications, previous acute care visits, and more) were the features used. Classify patients.

A total of 2702 young people were identified, 1384 of whom were identified as female (51.2%); 131 were Asian (4.8%); 266, Black (9.8%); 719, Hispanic (26.6%); and 1,319, White (48.8%). The remaining 233 people were determined to belong to “other race”. From this group there were 898 children (aged 6-12) and 1804 adolescents (aged 13-17).

Almost 50% of pediatric ED visits were related to SITB (n = 1286), while other visits included attention-deficit/hyperactivity disorder (ADHD; n = 272; 30.3%), self-harm, or suicide (n = 266; 29.6%), anxiety disorders (n = 207; 23.1%), depressive disorders (n = 196; 21.8%), or another symptom associated with MD (n = 193; 21.5%). The most common reason for visits in adolescents is depressive disorders (n = 747; 41.4%), followed by self-harm or suicide (n = 684; 37.9%), anxiety disorders (n = 561; 31.1%), ADHD ( n = 561; 31.1%). n = 306; 17%) and substance use-related disorders (n = 299; 12.7%). Researchers noted that suicide attempts were more common in adolescents than in children (9.3% vs. 6.5%; P. = 0.01). Similarly, adolescents more frequently report primary concerns about suicide (30% vs. 8.4%; P. = .001).

When it comes to detecting SITB, the analysis showed that the youngest group of children (ages 6-9) experienced the worst accuracy (81.2%; 95% CI, 75.3%-86.3%), with accuracy improving in older patients ( elderly) revealed that it increased. 10-12 years: 84.6%; 95% CI, 81.7%-87.2%) 13-17 years old: 92.4%; 95% CI, 90.5%-94%. The researchers also noted that baseline anxiety and SITB detection become more sensitive with age. ICD-10-CM codes were used.

Overall, aCS (using all available structured data) demonstrated superiority over CS (area under the receiver operating characteristic curve (AUROC), 0.975; 95% CI, 0.968-0.980 vs 0.894; 95% CI, 0.882-0.905 ; P.

“Various factors, including underlying psychopathology, reimbursement practices, stigma, and clinician biases, may explain why youth do not receive codes and core concerns about suicide,” the authors wrote.

Given these results, researchers see an opportunity to improve early detection of suicidal ideation.

“Phenotypes influence policymaking regarding potential treatments, allocation of resources, and therefore the health of populations. Our findings support the need to establish best practices for assessing phenotype definitions of SITB in youth and to base these practices on algorithmic measures of fairness… Changes in clinician practices, diagnostic codes, and key concerns “Meanwhile, without accurate and fair phenotype definitions, suicide prevention strategies will inadequately target the populations they aim to serve.”

References

1. Valtuille Z, Trebossen V, Ouldali N, et al. Pediatric hospitalizations and emergency room visits due to mental health issues and self-harm. JAMA Netw On. 2024;7(10):e2441874. doi:10.1001/jamanetworkopen.2024.41874

#2 Youth Rankings 2024. Mental Health America. Access date: 29 October 2024.