Health care contacts in the year before suicide death.
Open accessAbstract
Background Suicide prevention is a public health priority, but no data on the health care individuals receive prior to death are available from large representative United States population samples.Objective To investigate variation in the types and timing of health services received in the year prior to suicide, and determine whether a mental health condition was diagnosed.Design Longitudinal study from 2000 to 2010 within eight Mental Health Research Network health care systems serving eight states.Participants In all, 5,894 individuals who died by suicide, and were health plan members in the year before death.Main measures Health system contacts in the year before death. Medical record, insurance claim, and mortality records were linked via the Virtual Data Warehouse, a federated data system at each site.Key results Nearly all individuals received health care in the year prior to death (83 %), but half did not have a mental health diagnosis. Only 24 % had a mental health diagnosis in the 4-week period prior to death. Medical specialty and primary care visits without a mental health diagnosis were the most common visit types. The individuals more likely to make a visit in the year prior to death (p < 0.05) tended to be women, individuals of older age (65+ years), those where the neighborhood income was over $40,000 and 25 % were college graduates, and those who died by non-violent means.Conclusions This study indicates that opportunities for suicide prevention exist in primary care and medical settings, where most individuals receive services prior to death. Efforts may target improved identification of mental illness and suicidal ideation, as a large proportion may remain undiagnosed at death.
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The last clinical contact for the majority of people who die by suicide is either in an emergency department or in primary care.
“The last clinical contact for the majority of people who die by suicide is either in an emergency department or in primary care. 210”
From Suicide and suicide risk (2019) · cites this paper as [210]
The Results (‘As shown in Table’; page unavailable) report that 64% of people who died by suicide had a primary-care visit in the preceding year, while 36% had an emergency visit without a mental-health diagnosis. The paper counts visits within time windows, not the setting of each person’s last clinical contact, so it does not establish the claim about where the majority’s final contact occurred. (LLM, conf=0.84)
Experimental — accuracy not yet measuredHistorically, many patients at risk for suicide in routine clinical care are not detected, and those detected often do not receive suicide-specific intervention.
“Historically, many patients with suicide risk are not detected during routine clinical care, and those who are often do not receive suicide-specific intervention.”
From Emergency department safety assessment and follow-up evaluation 2: an implementation trial to improve suicide prevention. (2020) · cites this paper as [8]
The pattern of healthcare use before suicide is similar across different insurance types, including commercial insurance and Medicaid.
“These patterns remain consistent for individuals with varying types of insurance, including commercial insurance and Medicaid.11,15”
From Variation in patterns of health care before suicide: a population case-control study. (2019) · cites this paper as [11]
More than 80% of people visit a healthcare provider in the year before suicide or a suicide attempt, but most of those visits are in general medical settings and lack a recorded mental health or substance use disorder diagnosis.
“These data are consistent with other studies, which have found that >80% of individuals make a healthcare visit in the year before suicide or suicide attempt, though most visits occur in general medical settings and do not include a recorded mental health or substance use disorder diagnosis.11–14”
From Variation in patterns of health care before suicide: a population case-control study. (2019) · cites this paper as [11]
The study supports prior research showing that nearly all people who die by suicide make a healthcare visit in the year before death and about half contact the health system within a month of suicide.
“This study also supports prior research demonstrating that nearly all individuals who die by suicide make a healthcare visit in the year before death and approximately half make contact with the health system within a month of suicide.11,13”
From Variation in patterns of health care before suicide: a population case-control study. (2019) · cites this paper as [11]
The data support other recent studies indicating that only half of all individuals have a mental health diagnosis before suicide.
“However, these data also support other recent studies indicating that only half of all individuals have a mental health diagnosis before suicide.1,11”
From Variation in patterns of health care before suicide: a population case-control study. (2019) · cites this paper as [11]
About 80% of suicide decedents are seen by primary care providers in the year before death, while only 20% have contact with a mental health professional.
“Research further shows approximately 80% of suicide decedents are seen by primary care providers in the year prior to death, while only 20% have contact with a mental health professional.7,8”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [7]
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References 55 · Cited by 671
- Authors
- Ahmedani, B. K., Simon, G. E., Stewart, C., Beck, A., Waitzfelder, B. E., Rossom, R., Lynch, F., Owen-Smith, A., Hunkeler, E. M., Whiteside, U., Operskalski, B. H., Coffey, M. J., & Solberg, L. I.
- Affiliations
- Henry Ford Health (US)
- Group Health Cooperative (US)
- Kaiser Permanente (US)
- HealthPartners (US)
- Corresponding author
- Ahmedani, Brian K.
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2014-02-25
- Volume
- 29
- Issue
- 6
- Pages
- 870-877
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC4026491
- OpenAlex
- W1977934795
- Cited by
- 671
- References
- 55
- Citations by year
- 2026: 41 · 2025: 55 · 2024: 80 · 2023: 63 · 2022: 78 · 2021: 81 · 2020: 80 · 2019: 57 · 2018: 53 · 2017: 40 · 2016: 22 · 2015: 15 · 2014: 6
- FWCI
- 33.14
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Mental Health (U19MH092201)
- National Center for Complementary and Integrative Health (UH2AT007755)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Keywords
- suicide, health care utilization, psychiatric diagnosis, suicide prevention, primary care, suicidal ideation, health insurance beneficiaries
- MeSH terms
- Suicide Prevention, Adult, Aged, Ambulatory Care, Mental Disorders, Child, Delivery of Health Care, Diagnostic Errors, Female, Health Services Research, Humans, Insurance Claim Reporting, Longitudinal Studies, Male, Medical Records, Problem-Oriented, Mental Health, Preventive Health Services, Primary Health Care, Suicide, Time Factors, United States, Needs Assessment, Suicidal Ideation
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