High rate of healthcare visits before suicide attempts

Most people who attempt suicide make some type of healthcare visit in the weeks or months before the attempt, reports a study in the May issue of Medical Care.

The study also identifies racial/ethnic differences that may help to target suicide prevention efforts in the doctor's office and other health care settings. The lead author was Brian K. Ahmedani, PhD, LMSW, of Henry Ford Health System, Detroit, Mich.

Health Visits May Provide Chances for Suicide Prevention

Using data from the NIMH-funded Mental Health Research Network, the researchers identified nearly 22,400 individuals who made suicide attempts between 2009 and 2011. They analyzed healthcare visits before the attempt, with an eye on the possibilities for identifying people at risk for suicide.

The study focused on racial/ethnic differences in the types and timing of visits, including any documented mental health issues or substance abuse. Information on race/ethnicity was available for 78 percent of patients.

Overall, 38 percent of patients made some type of healthcare visit within a week before attempting suicide. The visit came within a month before the suicide attempt in 64 percent of patients, and within a year in nearly 95 percent. The percentage of visits with mental health or substance abuse diagnoses was about 25 percent within a week, 44 percent within a month, and 73 percent within a year before the attempt.

The study found significant racial/ethnic differences: 41 percent of white patients made any type of health visit within a week before the suicide attempt, compared to 35 percent for those in other groups. Nearly 27 percent of white patients made a mental health visit in the preceding week, compared to less than 20 percent for most other racial/ethnic groups.

Asian-Americans were the least likely to make any type of visit within a year before attempting suicide. Hawaiian/Pacific Islanders had the highest rate of hospital admissions and emergency department visits before a suicide attempt, but the lowest rate of mental health or substance abuse diagnoses.

"Overall, visits were most common in primary care and outpatient general medical settings," Dr. Ahmedani and coauthors write. Rates of visits for mental health specialty care ranged from nearly 60 percent for white to 40 percent for Asian patients.

More than one million people attempt suicide each year in the United States. The recently published National Strategy for Suicide Prevention concluded that healthcare is one of the best places to prevent suicide.

"This research provides essential information to aid suicide prevention efforts in health care systems," according to Dr. Ahmedani and coauthors. They discuss the implications for targeting suicide prevention efforts by race/ethnicity—including the need for "culturally competent mental illness detection and treatment" in minority groups.

Most previous prevention efforts have focused on emergency and mental health settings, rather than doctor's offices and other primary care settings, the researchers note. They conclude, "This study supports the promotion of suicide prevention within general outpatient settings, where most people visit before suicide attempt."