Healthcare Utilization in the Year Before Death By Suicide: A Multinomial Approach

Suicide prevention is a critical public health priority. The opportunity to intervene with this population is often in the primary care setting, but many at-risk individuals do not seek treatment. This study examines demographic differences in healthcare utilization patterns among suicide decedents, categorized into three groups: decedents who accessed care for mental health conditions, decedents who accessed care for non-mental health conditions, and decedents who did not access care. Data from the Arkansas All-Payers Claims Database (2013-2021) were linked to vital records to identify adult decedents who died by suicide. Healthcare utilization was categorized based on insurance claims filed in the year before death. Multinomial logistic regression was used to identify predictors of healthcare utilization, including age, gender, race, education, marital status, and rurality. Among 1678 decedents, 38.9% accessed care for mental health conditions, 23.5% accessed care for non-mental health conditions, and 37.5% did not access care in the year before death. Younger decedents (18-44 years) were 49% less likely to access mental health services and 81% less likely to access non-mental health services compared to seniors (65+ years; p < 0.0001). Men were 50% less likely to access mental health services than women (p < 0.0001). African-Americans were more likely to access care for non-mental health conditions (p = 0.01). Identifying decedent characteristics of suicide based on healthcare utilization can help develop targeted interventions for this population. Additional efforts should be made to encourage young people to seek healthcare more regularly, particularly during periods of severe stress.