Abstract
Objective
This study examined racial-ethnic and sex differences (and their intersections) in mental health service use prior to deliberate self-harm among young people enrolled in Medicaid.Methods
A retrospective cohort study was conducted by using Medicaid data from 25 states between January 1, 2011, and December 31, 2021. The cohort included 222,924 young people ages 9-25 years with a new self-harm diagnosis. Primary outcomes were any mental health service use 1, 6, and 12 months prior to self-harm, categorized as outpatient, inpatient, or emergency department visits. Logistic regression models with sex × race-ethnicity interaction terms estimated associations with service use, clustered by state and adjusted for covariates.Results
Overall, 34.2% of the cohort had a mental health visit in the month prior to self-harm, and 54.5% had a visit in the preceding year. The highest probabilities of any mental health service use in the month prior to self-harm were among non-Hispanic White (NHW) male (adjusted predicted probability [APP]=58.14%) and NHW female (APP=54.72%) individuals. The probabilities and odds of service use were higher for NHW, non-Hispanic Black, and Hispanic male individuals compared with their respective female counterparts for all service types and periods.Conclusions
Among young people enrolled in Medicaid, patterns of mental health service use prior to self-harm varied by sex and race-ethnicity. Culturally tailored mental health promotion strategies that address structural racism, provider bias, and system fragmentation may help reduce disparities in care and mitigate risks for self-harm and suicide.