Health care contacts in the year before suicide death

Abstract

Background: Suicide prevention is a public health priority, but no data on the health care individuals receive prior to death are available from large representative United States population samples.

Objective: To investigate variation in the types and timing of health services received in the year prior to suicide, and determine whether a mental health condition was diagnosed.

Design: Longitudinal study from 2000 to 2010 within eight Mental Health Research Network health care systems serving eight states.

Participants: In all, 5,894 individuals who died by suicide, and were health plan members in the year before death.

Main measures: Health system contacts in the year before death. Medical record, insurance claim, and mortality records were linked via the Virtual Data Warehouse, a federated data system at each site.

Key results: Nearly all individuals received health care in the year prior to death (83 %), but half did not have a mental health diagnosis. Only 24 % had a mental health diagnosis in the 4-week period prior to death. Medical specialty and primary care visits without a mental health diagnosis were the most common visit types. The individuals more likely to make a visit in the year prior to death (p < 0.05) tended to be women, individuals of older age (65+ years), those where the neighborhood income was over $40,000 and 25 % were college graduates, and those who died by non-violent means.

Conclusions: This study indicates that opportunities for suicide prevention exist in primary care and medical settings, where most individuals receive services prior to death. Efforts may target improved identification of mental illness and suicidal ideation, as a large proportion may remain undiagnosed at death.

Figure 1

Cumulative weekly percentage of individuals receiving health services in the year prior to suicide death, by visit type. MH denotes a visit with a Mental Health diagnosis; CD a visit with a Chemical Dependency diagnosis; IP an Inpatient stay; ED an Emergency Department visit; OP an Outpatient visit; PC a Primary Care visit; ‘Other’ includes all visits without an attached mental health or chemical dependency diagnosis code.