Objective To compare the type and frequency of healthcare visits in the year before suicide between decedents and controls. Patients and methods Cases (n=86) were Olmsted County, Minnesota residents whose death certificates listed “suicide” as the cause of death from January 1, 2000 through December 31, 2009. Each case had three age- and sex-matched controls (n=258). Demographic, diagnostic and healthcare usage data were abstracted from medical records. Conditional logistic regression was used to analyze differences in the likelihood of having had psychiatric and non-psychiatric visits in the year before death, as well as in visit types and frequencies 12 months, 6 months and 4 weeks before death. Results Cases and controls did not significantly differ in having had any healthcare exposure (p=.18). Suicide decedents, however, had significantly higher numbers of total visits in the 12 months, 6 months, and 4 weeks prior to death (all p<.001), were more likely to have carried psychiatric diagnoses in the previous year (OR 8.08; 95% CI 4.31 to 15.17, p<.001) and were more likely to have had outpatient and inpatient mental health visits (OR 1.24, 95% CI 1.05 to 1.47, p=.01, OR 6.76, 95% CI 1.39 to 32.96, p=.02, respectively). Only cases had had emergency department mental health visits; no control did. Conclusion Given that suicide decedents did not differ from controls in having had any healthcare exposure in the year before death, the fact alone that decedents saw a doctor provides no useful information about risk. Compared to controls, however, decedents had more visits of all types including psychiatric ones. Higher frequencies of healthcare contacts were associated with elevated suicide risk.

With providers screening less than half of SDs at any point in the year before death, and less than 60% of SDs ever endorsing SI, including none at final appointments, the findings of this naturalistic study bring into question both current screening practices and screening effectiveness. Nonetheless, when SDs were screened, they were significantly more likely to endorse SI than were controls, not 1 of whom ever expressed SI. Taken together, these data suggest that patients expressing SI at any point are at elevated risk for eventual suicide.

Background: When adolescents present with symptoms of unexplained weight loss, underweight, or poor appetite, eating disorders (EDs) are commonly on the list of differential diagnoses. However, the relationship of these symptoms to other psychiatric disorders is often less clear. Methods: Using the Rochester Epidemiology Project database, a retrospective cohort study of adolescents (13-18 years) with billing diagnoses of weight loss, underweight, or loss of appetite was conducted between January 2005 and December 2017. Patients who presented with conditions commonly associated with weight loss, underweight, or poor appetite (e.g., cancer) were excluded. This study sought to examine the proportion of patients who received ED and psychiatric diagnoses within 5 years of the index visit and patient characteristics associated with these diagnoses. Results: Of 884 patients diagnosed with symptoms of unexplained weight loss, underweight, or poor appetite, 662 patients (M age 5 15.8; SD 5 1.6; 66.0% female) met study criteria. Within 5 years of the index visit, the lifetime prevalence of all psychiatric disorders was 70% (n 5 461) and of EDs was 21% (n 5 141). For both psychiatric disorders and EDs, sex and race were significantly associated with receiving a diagnosis within 5 years. Decrease in body mass index (BMI) percentile was associated with receiving an ED diagnosis, whereas the highest historical BMI percentile was associated with receiving a psychiatric diagnosis. Conclusion: Patients presenting with symptoms of unexplained weight loss, underweight, or poor appetite are at risk not only for EDs but also for other psychiatric disorders that may require further assessment and follow-up.