Presented in part at the 2012 annual meetings of the Society for Adolescent Health and Medicine, New Orleans, LA and the Pediatric Academic Societies, Boston, MA, USA.
Identifying suicidal behavior among adolescents using administrative claims data†
Article first published online: 15 FEB 2013
Copyright © 2013 John Wiley & Sons, Ltd.
Pharmacoepidemiology and Drug Safety
Volume 22, Issue 7, pages 769–775, July 2013
How to Cite
Callahan, S. T., Fuchs, D. C., Shelton, R. C., Balmer, L. S., Dudley, J. A., Gideon, P. S., DeRanieri, M. M., Stratton, S. M., Williams, C. L., Ray, W. A. and Cooper, W. O. (2013), Identifying suicidal behavior among adolescents using administrative claims data. Pharmacoepidem. Drug Safe., 22: 769–775. doi: 10.1002/pds.3421
- Issue published online: 3 JUL 2013
- Article first published online: 15 FEB 2013
- Manuscript Accepted: 24 JAN 2013
- Manuscript Revised: 22 JAN 2013
- Manuscript Received: 25 OCT 2012
- suicidal behavior;
- administrative claims;
To assess the safety of psychotropic medication use in children and adolescents, it is critical to be able to identify suicidal behaviors from medical claims data and distinguish them from other injuries. The purpose of this study was to develop an algorithm using administrative claims data to identify medically treated suicidal behavior in a cohort of children and adolescents.
The cohort included 80 183 youth (6–18 years) enrolled in Tennessee's Medicaid program from 1995–2006 who were prescribed antidepressants. Potential episodes of suicidal behavior were identified using external cause-of-injury codes (E-codes) and ICD-9-CM codes corresponding to the potential mechanisms of or injuries resulting from suicidal behavior. For each identified episode, medical records were reviewed to determine if the injury was self-inflicted and if intent to die was explicitly stated or could be inferred.
Medical records were reviewed for 2676 episodes of potential self-harm identified through claims data. Among 1162 episodes that were classified as suicidal behavior, 1117 (96%) had a claim for suicide and self-inflicted injury, poisoning by drugs, or both. The positive predictive value of code groups to predict suicidal behavior ranged from 0–88% and improved when there was a concomitant hospitalization but with the limitation of excluding some episodes of confirmed suicidal behavior.
Nearly all episodes of confirmed suicidal behavior in this cohort of youth included an ICD-9-CM code for suicide or poisoning by drugs. An algorithm combining these ICD-9-CM codes and hospital stay greatly improved the positive predictive value for identifying medically treated suicidal behavior. Copyright © 2013 John Wiley & Sons, Ltd.