Factors Associated With 7-Day Follow-Up Outpatient Mental Healthcare in Older Adults Hospitalized for Suicidal Ideation, Suicide Attempt, and Self-Harm.

Abstract OBJECTIVE Older adults are one of the fastest growing age groups seeking emergency care for suicidal ideation and self-harm. Timely follow-up outpatient mental health care is important to suicide prevention, yet little is known about predictors of care continuity following hospital discharge. This study identified patient-, hospital-, and regional-level factors associated with 7-day follow-up outpatient mental health care in suicidal older adults. METHODS Retrospective cohort analysis using 2015 Medicare data for adults aged ≥ 65 years hospitalized for suicidal ideation, suicide attempt, or deliberate self-harm (n=27,257) linked with the American Hospital Association survey and Area Health Resource File. Rates and adjusted risk ratios stratified by patient, hospital, and regional variables were assessed for 7-day follow-up outpatient mental health care. RESULTS Overall, 30.3% of patients received follow-up mental health care within 7 days of discharge. However, follow-up rates were higher for patients with any mental health care within 30 days pre-hospitalization (43.7%) compared to patients with no recent mental health care (15.7%). Longer length of stay and care in psychiatric hospitals were associated with higher odds of follow-up. For patients with no mental health care in the 30 days pre-hospitalization, discharge from hospitals that were large, system-affiliated, academic medical centers, or provided hospitalist-based care were associated with lower odds of follow-up. Females were more likely to receive 7-day follow-up, whereas non-White patients were less likely to receive follow-up care. CONCLUSIONS Timely follow-up is influenced by multiple patient, hospital, and community characteristics. Findings highlight the need for quality improvement to promote successful transitions from inpatient to outpatient care.