Differences in Health Care Utilization in the Year Before Suicide Death: A Population-Based Case-Control Study

Area of Science:

• Public Health
• Epidemiology
• Health Services Research

Background:

• Understanding healthcare utilization patterns preceding suicide is crucial for prevention.
• Previous studies have not comprehensively analyzed healthcare usage in the year before suicide across diverse visit types.

Purpose of the Study:

• To compare healthcare usage between individuals who died by suicide and matched living controls in the year prior to suicide.
• To identify specific types and timing of healthcare visits associated with suicide risk.

Main Methods:

• A matched case-control study using data from an integrated US healthcare system (2009-2014).
• Cases (n=1221) and controls (n=3663) were matched 1:3 for age and sex.
• Conditional logistic regression and generalized estimating equation models analyzed visit types, timing, and frequency.

Main Results:

• Suicide decedents had higher odds of inpatient hospitalizations and non-mental health emergency department visits.
• Healthcare utilization, particularly mental health services, increased significantly closer to the time of suicide.
• No difference in outpatient non-mental health visits was observed between cases and controls.

Conclusions:

• Suicide decedents exhibit distinct healthcare utilization patterns, with increased inpatient and emergency visits.
• The frequency of healthcare use, especially mental health services, escalates as suicide nears.
• Findings highlight opportunities for targeted interventions within healthcare systems to identify and support at-risk individuals.