Patterns of Health Care Usage in the Year Before Suicide: A Population-Based Case-Control Study

Abstract

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.

Psychiatric Emergencies

“…55 Suicide decedents tend to spend more time in the hospital for both medical and psychiatric reasons in the months prior to their death, endorse lower global quality of life assessment scores, and suffer from more physical impairment. 29,53 Similar risk for depression and suicide is also found in adolescent populations with chronic physical illnesses. 56 While some illnesses cannot be cured, the amount of disability or functioning may be modifiable with therapy.…”

“…These include: Changes in mood, including any depressive symptoms, emotional distress, anger, irritability, or aggression 24,25 Anxiety or agitation 26,27 Sleep complaints 24 Evidence of unpredictable or impulsive behavior 25 Sudden change in life circumstances 28 Increase in alcohol or other drug useIncreasing healthcare utilization, including hospitalizations, office visits, and emergency room visits 29 Therapy non-adherence, including medications, physical therapy, and psychotherapyPresentation because of family/friend – more than 50% of individuals who presented to primary care providers before suicide were convinced to do so by family or friends 30 …”

“…Increasing healthcare utilization, including hospitalizations, office visits, and emergency room visits 29 …”

Suicide Prevention in Primary Care Medicine

“…1 Evidence, albeit limited, suggests that many suicide decedents had contact with a health care provider shortly before death. 3 The report by Chock et al 4 in the current issue of Mayo Clinic Proceedings highlights an important opportunity to expand suicide prevention in primary medical care settings and the potential for primary health care providers to take a larger role in suicide prevention. 5 Unlike most other studies examining the link between health care visits and suicide, Chock et al 4 used a control group to ascertain whether the pattern of health care use in suicide decedents was, or was not, different from that in nonsuicide patients.…”

“…3 Little is known about whether primary care use is higher in patients who die by suicide compared with patients who do not. The novel way in which Chock et al 4 used EHR data expands our knowledge in this area.…”