Building an Integrated Data Infrastructure to Examine the Spectrum of Suicide Risk Factors in Philadelphia Medicaid.

While there are many data-driven approaches to identifying individuals at risk of suicide, they tend to focus on clinical risk factors, such as previous psychiatric hospitalizations, and rarely include risk factors that occur in nonclinical settings, such as jails or emergency shelters. A better understanding of system-level encounters by individuals at risk of suicide could help inform suicide prevention efforts. In Philadelphia, we built a community-level data infrastructure that encompassed suicide death records, behavioral health claims, incarceration episodes, emergency housing episodes, and involuntary commitment petitions to examine a broader spectrum of suicide risk factors. Here, we describe the development of the data infrastructure, present key trends in suicide deaths in Philadelphia, and, for the Medicaid-eligible population, determine whether suicide decedents were more likely to interact with the behavioral health, carceral, and housing service systems compared to Medicaid-eligible Philadelphians who did not die by suicide. Between 2003 and 2018, there was an increase in the number of annual suicide deaths among Medicaid-eligible individuals, in part due to changes in Medicaid eligibility. There were disproportionately more suicide deaths among Black and Hispanic individuals who were Medicaid-eligible, who were younger on average, compared to suicide decedents who were never Medicaid-eligible. However, when we accounted for the racial and ethnic composition of the Medicaid population at large, we found that White individuals were four times as likely to die by suicide, while Asian, Black, Hispanic, and individuals of other races were less likely to die by suicide. Overall, 58% of individuals who were Medicaid-eligible and died by suicide had at least one Medicaid-funded behavioral health claim, 10% had at least one emergency housing episode, 25% had at least one incarceration episode, and 22% had at least one involuntary commitment. By developing a data infrastructure that can incorporate a broader spectrum of risk factors for suicide, we demonstrate how communities can harness administrative data to inform suicide prevention efforts. Our findings point to the need for suicide prevention in nonclinical settings such as jails and emergency shelters, and demonstrate important trends in suicide deaths in the Medicaid population.

Leisure Activity Enjoyment of Children with Autism Spectrum Disorders.

Enjoyment is a fundamental component of activity participation. This study compared leisure activity enjoyment experienced by typically developing children (TD; n = 64) and those with autism spectrum disorders (ASD; n = 67) from age 6 to 13. The TD children enjoyed formal and physical activities significantly more than the children with ASD. Symptom severity was negatively related to enjoyment of overall, formal, physical and social activities. Older children with ASD enjoyed overall, informal, recreational, and self-improvement activities significantly less than younger children, but no differences were seen across TD age groups. Children with ASD enjoyed swimming significantly more than TD children. Understanding patterns of activity enjoyment is useful for being better able to address a child's motivation to participate in various life activities.

Confidence-accuracy resolution in the misinformation paradigm is influenced by the availability of source cues.

After witnessing an event, people often report having seen details that were merely suggested to them. Evidence is mixed regarding how well participants can use confidence judgments to discriminate between their correct and misled memory reports. We tested the prediction that the confidence-accuracy relationship for misled details depends upon the availability of source cues at retrieval. In Experiment 1, participants (N=77) viewed a videotaped staged crime before reading a misleading narrative. After seven minutes or one week, the participants completed a cued recall test for the details of the original event. Prior to completing the test, all participants were warned that the narrative contained misleading details to encourage source monitoring. The results showed that the strength of the confidence-accuracy relationship declined significantly over the delay. We interpret our results in the source monitoring framework. After an extended delay, fewer diagnostic source details were available to participants, increasing reliance on retrieval fluency as a basis for memory and metamemory decisions. We tested this interpretation in a second experiment, in which participants (N=42) completed a source monitoring test instead of a cued recall test. We observed a large effect of retention interval on source monitoring, and no significant effect on item memory. This research emphasizes the importance of securing eyewitness statements as soon as possible after an event, when witnesses are most able to discriminate between information that was personally seen and information obtained from secondary sources.