{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T20:50:03Z","timestamp":1768423803323,"version":"3.49.0"},"reference-count":31,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T00:00:00Z","timestamp":1689033600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Clin Psychol"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Unhoused individuals have high rates of suicidal ideation (SI)\u00a0and suicidal behaviors (SB),\u00a0but few have studied the relative timing of homelessness and SI\/SB.\u00a0Our study examines the potential to use state\u2010wide electronic health record data from Rhode Island's health information exchange (HIE)\u00a0to identify temporal relationships, service utilization, and associations of SI\/SB\u00a0among unhoused individuals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We use timestamped HIE data for 5368 unhoused patients to analyze service utilization and the relative timing of homelessness versus SI\/SB\u00a0onset. Multivariable models identified associations of SI\/SB,\u00a0hospitalization, and repeat acute care utilization within 30 days from clinical features representing 10,000+ diagnoses captured within the HIE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The onset of SI typically precedes homelessness onset, while the onset of SB typically follows. Weekly rates of suicide\u2010related service utilization increased over 25 times the baseline rate during the week before and after homelessness onset. Over 50% of encounters involving SI\/SB result in hospitalization. Of those engaging in acute care for suicide\u2010related reasons, we found high rates of repeat acute care encounters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>HIEs are a particularly valuable resource for understudied populations. Our study demonstrates how longitudinal, multi\u2010institutional data from an HIE can be used to characterize temporal associations, service utilization, and clinical associations of SI and behaviors among a vulnerable population at scale. Increasing access to services that address co\u2010occurring SI\/SB, mental health, and substance use is needed.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jclp.23566","type":"journal-article","created":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T18:54:24Z","timestamp":1689101664000},"page":"2542-2555","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Characterizing suicidal ideation, suicidal behaviors, and service utilization among unhoused individuals using a health information exchange"],"prefix":"10.1002","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4046-0266","authenticated-orcid":false,"given":"Zandra V.","family":"Ho","sequence":"first","affiliation":[{"name":"Warren Alpert Medical School Brown University Providence Rhode Island USA"},{"name":"Center for Biomedical Informatics Brown University Providence Rhode Island 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