@article{ref1,
title="Characterizing suicidal ideation, suicidal behaviors, and service utilization among unhoused individuals using a health information exchange",
journal="Journal of clinical psychology (Hoboken)",
year="2023",
author="Ho, Zandra V. and Arias, Sarah A. and Kunicki, Zachary J. and Sarkar, Indra Neil and Chen, Elizabeth S.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="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. <br><br>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. <br><br>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. <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="0021-9762",
doi="10.1002/jclp.23566",
url="http://dx.doi.org/10.1002/jclp.23566"
}