Patient portal message characteristics and reported thoughts of self-harm and suicide: A retrospective cohort study

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.

Using patient portal messages sent between 1 January 2013 and 30 June 2017, we searched for words and letter combinations 'suicid' (to identify words suicide and suicidal), 'depress' (for depression, depressed, depressing), 'harm himself' (or 'herself 'or 'myself'), 'hurt himself' ('herself' or 'myself'), 'kill', 'shoot', 'cutting', 'knife', 'gun', 'overdose', 'over dose' and 'jump'.

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 'suicide', 'die', 'depress' and 'harm/hurt my/her/himself'.

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.