Contact With Mental Health and Primary Care Providers Before Suicide: A Review of the Evidence

Abstract

Objective-This study examined rates of contact with primary care and mental health care professionals by individuals before they died by suicide.Method-The authors reviewed 40 studies for which there was information available on rates of health care contact and examined age and gender differences among the subjects.Results-Contact with primary care providers in the time leading up to suicide is common. While three of four suicide victims had contact with primary care providers within the year of suicide, approximately one-third of the suicide victims had contact with mental health services. About one in five suicide victims had contact with mental health services within a month before their suicide. On average, 45% of suicide victims had contact with primary care providers within 1 month of suicide. Older adults had higher rates of contact with primary care providers within 1 month of suicide than younger adults.Conclusions-While it is not known to what degree contact with mental health care and primary care providers can prevent suicide, the majority of individuals who die by suicide do make contact with primary care providers, particularly older adults. Given that this pattern is consistent with overall health-service-seeking, alternate approaches to suicide-prevention efforts may be needed for those less likely to be seen in primary care or mental health specialty care, specifically young men.Suicide is a serious public health problem. Among industrialized countries in 1990, suicide was among the top 10 causes of death (1). In 1998 approximately 30,000 people died by suicide in the United States, making it the eighth leading cause of death (2). Recently, the National Strategy for Suicide Prevention was issued (3), outlining specific goals intended to prevent suicide in the United States. Programs aimed at improving the ability of primary care and mental health professionals to identify and treat those at risk for suicide are recommended. A primary goal of this review was to consider the potential of such strategies. Although general estimates of service contact before suicide are often cited (4, 5), there has been no systematic review of how frequently different types of health care professionals HHS Public Access Author Manuscript Author Manuscript Author ManuscriptAuthor Manuscript have contact with various populations who eventually commit suicide. At least one review has examined contacts with health and mental health care providers before suicide (6); however, its usefulness was limited because it did not take into consideration specific populations that eventually commit suicide, such as older adults or youth, who may differ in their rates of health care contact.Despite limited systematic reviews of health care contacts before suicide, some prevention strategies involving health care providers have been suggested. On the basis of studies of psychological autopsies and record reviews from general practitioner sites, it has been recommended that detecting and treating depression in primary care ...

Surveillance for Violent Deaths — National Violent Death Reporting System, 17 States, 2013

“…Other studies have indicated that on average, as many as 45.0% of persons who die by suicide had visited their primary care physician within 1 month of their death (28) and as many as 67.0% of persons who attempt suicide receive medical attention as a result of their attempt (29). Such findings suggest opportunities for suicide prevention.…”

Warning signs for suicide within a week of healthcare contact in Veteran decedents

“…A review of healthcare contact before suicide indicated that 64% of decedents made contact with healthcare providers within a month (30 days) of their suicide (Luoma et al, 2002). However, few studies examined factors that were associated with immediate or near-term risk.…”

Practical Suicide-Risk Management for the Busy Primary Care Physician

“…10,11 First, patients dying by suicide visit primary care physicians more than twice as often as mental health clinicians. 10 A review of studies analyzing this clinical scenario estimated 45% of those dying by suicide saw their primary care physician in the month before their death. 10 Only 20% saw a mental health professional 10 in the preceding month.…”

“…10 A review of studies analyzing this clinical scenario estimated 45% of those dying by suicide saw their primary care physician in the month before their death. 10 Only 20% saw a mental health professional 10 in the preceding month. Women and older patients are more likely to have sought care in the month before suicide 10 than men and younger patients.…”

“…10 Only 20% saw a mental health professional 10 in the preceding month. Women and older patients are more likely to have sought care in the month before suicide 10 than men and younger patients. Second, generalists (internists, pediatricians, family physicians) write most antidepressant prescriptions (62%) in the United States.…”