{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:09:23Z","timestamp":1787501363419,"version":"build-2736575974"},"reference-count":31,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2019,11,14]],"date-time":"2019-11-14T00:00:00Z","timestamp":1573689600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Telemed Telecare"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>As use of electronic portal communication with healthcare teams increases, processes that effectively recognize messages that contain critical information are needed. This study aims to evaluate whether certain language and other characteristics of patient portal messages are associated with expressions of self-harm and suicidal ideation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using patient portal messages sent between 1 January 2013 and 30 June 2017, we searched for words and letter combinations \u2018suicid\u2019 (to identify words suicide and suicidal), \u2018depress\u2019 (for depression, depressed, depressing), \u2018harm himself\u2019 (or \u2018herself \u2018or \u2018myself\u2019), \u2018hurt himself\u2019 (\u2018herself\u2019 or \u2018myself\u2019), \u2018kill\u2019, \u2018shoot\u2019, \u2018cutting\u2019, \u2018knife\u2019, \u2018gun\u2019, \u2018overdose\u2019, \u2018over dose\u2019 and \u2018jump\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 831,009 messages, 11,174 messages contained one or more search terms. We manually reviewed 7,736 messages for content expressing self-harm or suicidality. Of the reviewed messages, 3.2% indicated thoughts of self-harm or suicide and 2.2% of messages suggested active suicidality. Of those expressing any thoughts of self-harm or suicide, 13.4% mentioned a specific plan, 20% were passively suicidal. Messages indicating thoughts of self-harm and suicide were more common in patients who were unmarried, non-white and younger than 18 years. Factors significantly associated with thoughts of self-harm were messages addressed to psychiatry or containing the letter combinations \u2018suicide\u2019, \u2018die\u2019, \u2018depress\u2019 and \u2018harm\/hurt my\/her\/himself\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Certain letter combinations and patient portal message characteristics may be associated with expressions of self-harm and suicide. These factors should be considered as we develop systems of effectively screening patient portal messages for critical clinical information.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1357633x19887262","type":"journal-article","created":{"date-parts":[[2019,11,15]],"date-time":"2019-11-15T01:08:46Z","timestamp":1573780126000},"page":"501-508","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["Patient portal message characteristics and reported thoughts of self-harm and suicide: A retrospective cohort study"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6170-4592","authenticated-orcid":false,"given":"Michelle","family":"Duvall","sequence":"first","affiliation":[{"name":"Department of Family Medicine, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick","family":"North","sequence":"additional","affiliation":[{"name":"Department of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Leasure","sequence":"additional","affiliation":[{"name":"Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1970-1344","authenticated-orcid":false,"given":"Jennifer","family":"Pecina","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,11,14]]},"reference":[{"key":"bibr1-1357633X19887262","unstructured":"Centers for Medicare & Medicaid Services. EHR incentive programs in 2015 through 2017 patient electronic access, https:\/\/www.cms.gov\/Regulations-and-Guidance\/Legislation\/EHRIncentivePrograms\/Downloads\/2016_PatientElectronicAccess.pdf (2016, accessed 7 August 2019)."},{"key":"bibr2-1357633X19887262","unstructured":"National Learning Consortium. How to optimize patient portals for patient engagement and meet meaningful use requirements, https:\/\/www.healthit.gov\/sites\/default\/files\/nlc_how_to_optimizepatientportals_for_patientengagement.pdf (2013, accessed 7 August 2019)."},{"key":"bibr3-1357633X19887262","unstructured":"Centers for Medicare & Medicaid Services. Stage 2 Eligible professional meaningful use core measures measure 17 of 17, https:\/\/www.cms.gov\/Regulations-and-Guidance\/Legislation\/EHRIncentivePrograms\/downloads\/Stage2_EPCore_17_UseSecureElectronicMessaging.pdf (2012, accessed 7 August 2019)."},{"key":"bibr4-1357633X19887262","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2016.05.150371"},{"key":"bibr5-1357633X19887262","doi-asserted-by":"publisher","DOI":"10.1089\/pop.2015.0034"},{"key":"bibr6-1357633X19887262","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2010.0048"},{"key":"bibr7-1357633X19887262","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2016.08.034"},{"key":"bibr8-1357633X19887262","volume":"10","author":"Deslich S","year":"2013","journal-title":"Perspect Health Inf Manag"},{"issue":"2","key":"bibr9-1357633X19887262","volume":"12","author":"Garcia-Lizana F","year":"2010","journal-title":"Prim Care Companion J Clin Psychiatry"},{"key":"bibr10-1357633X19887262","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-159-10-201311190-00006"},{"key":"bibr11-1357633X19887262","doi-asserted-by":"publisher","DOI":"10.1136\/amiajnl-2012-001208"},{"key":"bibr12-1357633X19887262","unstructured":"Crisis Text Line. Crisis Trends, www.crisistrends.org (2018, accessed 8 May 2019)."},{"key":"bibr13-1357633X19887262","unstructured":"Hedegaard H, Curtin SC, Warner M.\n                      Suicide mortality in the United States, 1999\u20132017\n                      . NCHS Data Brief no. 330. Hyattsville, MD: National Center for Health Statistics, 2018."},{"key":"bibr14-1357633X19887262","unstructured":"The Joint Commission.\n                      Sentinel event alert\n                      .\n                      Detecting and treating suicide ideation in all settings.\n                      Issue no. 56, 24 February 2016. Oak Brook (IL), Joint Commission."},{"key":"bibr15-1357633X19887262","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.159.6.909"},{"key":"bibr16-1357633X19887262","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0085733"},{"key":"bibr17-1357633X19887262","unstructured":"National Institute of Health Mental. Health information statistics, suicide, https:\/\/www.nimh.nih.gov\/health\/statistics\/suicide.shtml (2019, accessed 10 April 2019)."},{"key":"bibr18-1357633X19887262","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss6708a1"},{"key":"bibr19-1357633X19887262","doi-asserted-by":"publisher","DOI":"10.1136\/jech.54.4.254"},{"key":"bibr20-1357633X19887262","unstructured":"Centers for Disease Control and Prevention. National Vital Statistics System, Vital Signs 2018, https:\/\/www.cdc.gov\/vitalsigns\/suicide\/infographic.html (2018, accessed 7 Aug 2019)."},{"key":"bibr21-1357633X19887262","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/8708434"},{"key":"bibr22-1357633X19887262","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2018.17101167"},{"key":"bibr23-1357633X19887262","first-page":"641","volume":"2017","author":"Downs J","year":"2018","journal-title":"AMIA Annu Symp Proc"},{"key":"bibr24-1357633X19887262","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2017.06.004"},{"key":"bibr25-1357633X19887262","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201700458"},{"key":"bibr26-1357633X19887262","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2013.02.002"},{"key":"bibr27-1357633X19887262","first-page":"514","volume":"2006","author":"Lober W","year":"2006","journal-title":"AMIA Annu Symp Proc"},{"key":"bibr28-1357633X19887262","doi-asserted-by":"publisher","DOI":"10.1136\/amiajnl-2011-000473"},{"issue":"3","key":"bibr29-1357633X19887262","first-page":"251","volume":"36","author":"Sanders M","year":"2013","journal-title":"JACM"},{"key":"bibr30-1357633X19887262","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1691"},{"key":"bibr31-1357633X19887262","doi-asserted-by":"publisher","DOI":"10.1037\/a0033911"}],"container-title":["Journal of Telemedicine and Telecare"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1357633X19887262","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1357633X19887262","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1357633X19887262","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T03:13:33Z","timestamp":1777691613000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1357633X19887262"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,14]]},"references-count":31,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2021,9]]}},"alternative-id":["10.1177\/1357633X19887262"],"URL":"https:\/\/doi.org\/10.1177\/1357633x19887262","relation":{},"ISSN":["1357-633X","1758-1109"],"issn-type":[{"value":"1357-633X","type":"print"},{"value":"1758-1109","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,14]]}}}