Comparisons of Mental Health Treatment Frequency and Risk of Suicidal Thoughts and Behaviors Among Youth

Suicide is a leading cause of death for adolescents and young adults, or transitional age youth, and suicidal thoughts and behaviors (STBs) are among the top predictors of suicide. This study aimed to compare the effectiveness of low versus high frequency mental health (MH) specialist visits at preventing suicidal thoughts and behaviors (STBs) among adolescents and transitional age youth receiving combined psychotherapy and psychotropic medication treatment in a culturally-diverse community health system in the United States. Between 2010-2020, we identified 4,888 individuals (12-25 years) with MH disorders who received at least one outpatient psychotherapy visit and one psychotropic medication order during their index treatment month. In the 10-12 months following the index month, unadjusted STBs were higher (3.20 %; 95 % CI 0.49 %, 5.89 %; p < 0.001) in youth with consistently high frequency MH specialist visits (4.40 %) relative to low (1.20 %). After balancing time-varying covariates, STBs were lower, but not statistically different in the consistently high relative to low group (Diff=-1.93 %; 95 % CI -4.56 %, 0.70 %; p = 0.150). Such adjustment for confounding by mental health severity indicators may strengthen evaluations of community-based treatment in diverse populations, where conventional randomization is impossible.