Symposia
Dissemination & Implementation Science
Shari Jager-Hyman, Ph.D.
Assistant Professor
University of Pennsylvania
Philadelphia, Pennsylvania
Shari Jager-Hyman, Ph.D.
Assistant Professor
University of Pennsylvania
Philadelphia, Pennsylvania
Matt Pieri, BA
Clinical research Coordinator
University of Pennsylvania
Philadelphia, Pennsylvania
Molly Candon, PhD
Assistant Professor
University of Pennsylvania
Philadelphia, Pennsylvania
Gabriela K. Khazanov, Ph.D.
Research Psychologist
Corporal Michael J Crescenz VA Medical Center
Philadelphia, Pennsylvania
Courtney Wolk, Ph.D.
Assistant Professor
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania
Background: Primary care is an ideal setting to intervene to reduce suicide risk. People across the lifespan visit primary care more than any other medical specialty, and the majority of individuals who die by suicide interact with a primary care clinician in the year prior to death. Increasingly, primary care is being called on to identify individuals at risk for suicide by systematic sreening using instruments such as the Patient Health Questionnaire-9 (PHQ-9) and to connect these patients to mental health providers. However,only half of referred patients attend an initial mental health visit. Factors that influence whether or not these patients are willing to engage in mental health services through the Collaborative Care Model (CoCM) have not been rigorously studied.
Objective: We used electronic health records (EHR) to identify characteristics of patients at risk for suicide who do or do not attend a CoCM visit following referral.
Methods: The sample comprised adults reporting ≥1 on the PHQ-9 suicide item who were referred for collaborative care from Penn Medicine primary care practices between 2018 and mid-2021 (N = 772). We first compared follow-up rates for patients with and without an elevated PHQ-9 suicide item. Next, we used logistic regressions to identify patient characteristics (e.g., race/ethnicity, financial security, clinical characteristics) associated with engagement in CoCM.
Results: Individuals at risk for suicide were similarly likely to follow-up with CoCM as individuals who are not at risk for suicide. We also found that Black individuals were more likely to attend an initial CoCM visit post-referral, while employed individuals were less likely to attend. Additional analyses are ongoing.
Discussion: Early findings suggest that individuals at risk for suicide are willing to engage in CoCM. While preliminary, these analyses will inform the development of scalable and feasible implementation strategies to increase treatment initiation for individuals at risk for suicide, which will be iteratively tested in a future phase of the study. Effective strategies to bolster mental health treatment initiation hold the potential to reduce mortality for this at-risk population.