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Prev Med. 2019 Aug 7;127:105796. doi: 10.1016/j.ypmed.2019.105796. [Epub ahead of print]

Variation in patterns of health care before suicide: A population case-control study.

Author information

1
Henry Ford Health System, Center for Health Policy and Health Services Research, United States of America; Henry Ford Health System, Behavioral Health Services, United States of America. Electronic address: bahmeda1@hfhs.org.
2
Henry Ford Health System, Center for Health Policy and Health Services Research, United States of America.
3
Henry Ford Health System, Public Health Sciences, United States of America.
4
Kaiser Permanente Colorado, Institute for Health Research, United States of America.
5
Kaiser Permanente Hawaii, Center for Health Research, United States of America.
6
HealthPartners Institute, United States of America.
7
Kaiser Permanente Georgia, Center for Research and Evaluation, United States of America; Georgia State University, School of Public Health, United States of America.
8
Kaiser Permanente Northwest, Center for Health Research, United States of America.
9
Harvard Medical School, United States of America; Harvard Pilgrim Health Care Institute, United States of America.
10
Henry Ford Health System, Behavioral Health Services, United States of America.
11
Henry Ford Health System, Center for Health Policy and Health Services Research, United States of America; Henry Ford Health System, Behavioral Health Services, United States of America.
12
Center for Population Health, University of Connecticut Health Center, United States of America.
13
Essentia Health, Essentia Institute of Rural Health, United States of America.
14
Kaiser Permanente Washington, Health Research Institute, United States of America.

Abstract

BACKGROUND:

The United States has experienced a significant rise in suicide. As decision makers identify how to address this national concern, healthcare systems have been identified as an optimal location for prevention.

OBJECTIVE:

To compare variation in patterns of healthcare use, by health setting, between individuals who died by suicide and the general population.

DESIGN:

Case-Control Study.

SETTING:

Eight healthcare systems across the United States.

PARTICIPANTS:

2674 individuals who died by suicide between 2000 and 2013 along with 267,400 individuals matched on time-period of health plan membership and health system affiliation.

MEASUREMENTS:

Healthcare use in the emergency room, inpatient hospital, primary care, and outpatient specialty setting measured using electronic health record data during the 7-, 30-, 60-, 90-, 180-, and 365-day time periods before suicide and matched index date for controls.

RESULTS:

Healthcare use was more common across all healthcare settings for individuals who died by suicide. Nearly 30% of individuals had a healthcare visit in the 7-days before suicide (6.5% emergency, 16.3% outpatient specialty, and 9.5% primary care), over half within 30 days, and >90% within 365 days. Those who died by suicide averaged 16.7 healthcare visits during the year. The relative risk of suicide was greatest for individuals who received care in the inpatient setting (aOR = 6.23). There was both a large relative risk (aOR = 3.08) and absolute utilization rate (43.8%) in the emergency room before suicide.

LIMITATIONS:

Participant race/ethnicity was not available. The sample did not include uninsured individuals.

CONCLUSIONS:

This study provides important data about how care utilization differs for those who die by suicide compared to the general population and can inform decision makers on targeting of suicide prevention activities within health systems.

KEYWORDS:

Health services; Mental health; Suicide

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