Risk Factors for Deliberate Self-harm and Suicide Among Adolescents and Young Adults With First-Episode Psychosis

Aubrey M. Moe; Elyse Llamocca; Heather M. Wastler; Danielle L. Steelesmith; Guy Brock; Jeffrey A. Bridge; Cynthia A. Fontanella


Schizophr Bull. 2022;48(2):414-424. 

In This Article


Study Design and Cohort

A retrospective longitudinal cohort design was used to examine the association between risk factors and DSH and suicide among adolescents and young adults with FEP. The study population included all youth aged 15–24 years with at least 1 inpatient claim or 2 outpatient claims with a psychosis diagnosis (supplementary table S1) between June 30, 2010 and December 31, 2017. The index diagnosis was classified as the first psychosis diagnosis. Previous research supports the validity of the use of claims data to accurately identify individuals with psychosis.[32] Youth were continuously enrolled in Medicaid during the 180 days prior to the index diagnosis (pre-period). Youth were followed from index diagnosis until age 25, the end of Medicaid enrollment, study outcome (i.e., death or DSH), or the end of the study period, whichever occurred first. All procedures were approved by The Ohio State University institutional review board. A waiver of informed consent was granted because the study involved secondary data with limited identifiable information and no more than minimal risk.

Data Sources

Data were abstracted from Ohio Medicaid claims and death certificate files. Claims data were obtained from the state's Department of Jobs and Family Services, and death records were obtained from the Ohio Department of Health. Medicaid data included eligibility, outpatient claims, and inpatient claims files. The eligibility files included information about monthly Medicaid enrollment status and enrollee demographics. The claims files included information on hospitalizations, physician visits (office or hospital-based), service dates, Current Procedural Terminology and Healthcare Common Procedure Coding System procedure codes, and ICD-9-CM and/or ICD-10 diagnoses.

Death certificates provided the ICD-10 cause of death codes. Medicaid claims data were linked with the death certificate using a matching algorithm from prior research.[33,34]