To examine the main metrics for implementation of the ZSI by mutually exclusive racial/ethnic groups: Black, Hispanic, Asian, White, HPI, AIAN, Other (includes all other categories) in Mental Health Specialty care. Identification will be lower for all groups except White patients, however, the remaining metrics are exploratory and thus do not have hypotheses.
To understand if suicide prevention is implemented equitably in mental health specialty care.
Main Zero Suicide Evaluation Study Outcome Paper:
Examine changes in suicide attempt rates before and after implementation of Zero Suicide in primary care and outpatient mental health specialty settings.
Main suicide outcome paper for primary care and outpatient mental health specialty settings in the ZS Evaluation Study
Examine the rates of uptake of screening (PHQ9- item9), follow-up assessment (CSSRS or equivalent), and safety planning separately across the six systems and by PC, BH. Report overall means and measures of spread, then show graphs for each system/setting (12 graphs) that have all three measures on each graph. Figure 1 would be the rates with 6 graphs for BH and Figure 2 would be the rates with 6 graphs for PC. Table 1 would be overall demographics, Table 2 would be the numerators/denominators for each of the measures by settings. Discuss penetration differences in the population by looking at the absolute numbers screened as well as the rates of screening within setting. Maybe in the discussion talk about some of the common and unique implementation strategies across systems.
Investigate whether changes in opioid prescribing patterns impact suicide attempt rates using an interrupted time series design
Opioid prescribing decreased rapidly over the last 10 years. Given that opioids are commonly used as a means for suicide, reductions in opioid availability may lead to long-term reductions in suicide attempts. Nonetheless, there is some documented concern about short term increases in suicide attempt after immediate discontinuation from opioid medication. This study will examine both short and long term changes in suicide attempt after population level decreases in opioid prescribing across 6 health systems.