TY - JOUR
T1 - Portal Message Language Use Prior to Suicide, Suicide Attempts, and Hospitalization for Depression
AU - Duvall, Michelle J.
AU - Miller, Nathaniel E.
AU - North, Frederick
AU - Leasure, William B.
AU - Pecina, Jennifer L.
N1 - Publisher Copyright:
Copyright © 2022, Mary Ann Liebert, Inc.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Introduction: Previous research suggests patients may be willing to communicate serious psychiatric concerns through patient portals. Methods: Retrospective chart review of portal messages sent by patients who had an emergency department (ED) visit or hospitalization for depression, self-harm, or suicidality or had a completed suicide (cases) was reviewed for content that was suggestive of depression or self-harm and language indicating emotional distress. Comparison with a randomly selected group (controls) was performed. Results: During the study period 420 messages were sent by 149 patients within 30 days of death by suicide, ED visit, and/or hospitalization related to depression, suicidality, or suicide attempt. Thirteen patients died by suicide but only 23% (3 of 13) sent one or more portal messages within 30 days before their death. None mentioned thoughts of self-harm. There were 271 messages sent by patients who were hospitalized, 142 messages by those who presented to the ED, and 56 messages patients who attempted suicide. Patient messages from cases were more likely than messages from controls to convey a depressed mood (17.1% vs. 3.1%, odds ratio 6.5; 95% confidence interval 3.6-11.9, p < 0.0001), thoughts of suicide or self-harm (4.8% vs. 0% p < 0.0001), or have a distressed tone (24.0% vs. 1.7%, odds ratio 18.7; 95% confidence interval 8.6-41, p < 0.0001). Conclusions: Patient portal messages from patients with subsequent hospitalizations for depression and suicidality do report thoughts of depression, distress, and thoughts of self-harm. However, portal use before completed suicide was not helpful at identifying at-risk patients although total numbers were small.
AB - Introduction: Previous research suggests patients may be willing to communicate serious psychiatric concerns through patient portals. Methods: Retrospective chart review of portal messages sent by patients who had an emergency department (ED) visit or hospitalization for depression, self-harm, or suicidality or had a completed suicide (cases) was reviewed for content that was suggestive of depression or self-harm and language indicating emotional distress. Comparison with a randomly selected group (controls) was performed. Results: During the study period 420 messages were sent by 149 patients within 30 days of death by suicide, ED visit, and/or hospitalization related to depression, suicidality, or suicide attempt. Thirteen patients died by suicide but only 23% (3 of 13) sent one or more portal messages within 30 days before their death. None mentioned thoughts of self-harm. There were 271 messages sent by patients who were hospitalized, 142 messages by those who presented to the ED, and 56 messages patients who attempted suicide. Patient messages from cases were more likely than messages from controls to convey a depressed mood (17.1% vs. 3.1%, odds ratio 6.5; 95% confidence interval 3.6-11.9, p < 0.0001), thoughts of suicide or self-harm (4.8% vs. 0% p < 0.0001), or have a distressed tone (24.0% vs. 1.7%, odds ratio 18.7; 95% confidence interval 8.6-41, p < 0.0001). Conclusions: Patient portal messages from patients with subsequent hospitalizations for depression and suicidality do report thoughts of depression, distress, and thoughts of self-harm. However, portal use before completed suicide was not helpful at identifying at-risk patients although total numbers were small.
KW - depression
KW - electronic medical record
KW - patient portal
KW - portal messaging
KW - secure message
KW - suicide
KW - suicide attempt
KW - telemedicine
KW - telepsychiatry
UR - http://www.scopus.com/inward/record.url?scp=85135596934&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85135596934&partnerID=8YFLogxK
U2 - 10.1089/tmj.2021.0318
DO - 10.1089/tmj.2021.0318
M3 - Article
C2 - 34936819
AN - SCOPUS:85135596934
SN - 1530-5627
VL - 28
SP - 1143
EP - 1150
JO - Telemedicine and e-Health
JF - Telemedicine and e-Health
IS - 8
ER -