The mental health conditions of most people who commit suicide remain undiagnosed, even though many visit a primary care provider or medical specialist in the year before they die, according to a national study led by Henry Ford Health System with the Mental Health Research Network.
Among those in the study, 83 percent received health care treatment in the year prior to dying, and they used medical and primary care services more frequently than any other health service. However, a mental health diagnosis was made in less than half (45 percent) of these cases.
To help prevent suicides, health care providers should therefore become more attuned to their patients’ mental health state and possible suicidal thoughts, concluded the study led by Brian K. Ahmedani, Ph.D., assistant scientist in the Center for Health Policy and Health Services Research at Henry Ford Health System in Detroit.
“Many suicides might be prevented, and a national suicide reduction goal may be met, if more primary care doctors and specialists receive and use training to identify and treat patients most at risk,” says Dr. Ahmedani.
The study is published online in the Journal of General Internal Medicine.
Suicide is the 10th leading cause of death in the U.S. and the No. 1 cause of injury-related death, recently topping motor vehicle deaths. It accounts for the loss of nearly 37,000 American lives each year, according to the Centers for Disease Control and Prevention.
While previous research suggested that more suicides could be prevented, this study is currently the largest investigation of suicide and health services use.
Ahmedani and colleagues in the Mental Health Research Network studied the medical records of 5,894 health plan members in eight states who committed suicide between 2000 and 2010. This methodology provided data on the health care received by people who commit suicide prior to their deaths
Of those seeking medical attention in the four weeks before they died, 25 percent were diagnosed with a mental health condition; one in every five people who committed suicide made a health care visit in the week before they died.
In comparison, only 5 percent of people who committed suicide received psychiatric hospitalization, and 15 percent received such treatment in the year prior to committing suicide.
The largest number of suicides occurred among men. Among all suicides, 79 percent were by violent methods: 48.6 percent firearms; 22 percent hanging; 3.6 percent jumping; 2 percent sharp or blunt objects; 1.6 percent drowning; and 1.5 percent by other means. The remaining suicides studied were by non-violent means: 20.2 percent poisoning and 0.6 percent by other means.
Drilling deeper into the data, the researchers found that only about 25 percent of the suicides had a mental health diagnosis within a month of their deaths, and those most likely to seek medical treatment during the year before their suicides were women, ages 65 or older, and those who died by non-violent means.
Ahmedani says this study provides important information to help target future prevention in order to achieve the goals set forth in 2012 by the U.S. Surgeon General and the National Action Alliance for Suicide Prevention to reduce American suicides by 20 percent in five years.
“The data clearly told us that although a large proportion of those who committed suicide had health system contact in the year before their death, a mental health diagnosis was commonly absent,” Dr. Ahmedani explains. “Greater efforts need to be made to assess mental health and suicide risk.”
“And because most visits occurred in primary care or medical specialty settings, suicide prevention in these clinics would likely reach the largest number of individuals.”
Funding: National Institute of Mental Health; U19MH092201.
Participating members of the Mental Health Research Network included: Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit; Group Health Cooperative, Group Health Research Institute, Seattle; Kaiser Permanente Colorado, Institute for Health Research, Denver; Kaiser Permanente Hawaii, Center for Health Research, Honolulu; HealthPartners, Institute for Education and Research, Minneapolis; Kaiser Permanente Northwest, Center for Health Research, Portland; Kaiser Permanente Georgia, Center for Health Research, Atlanta; Kaiser Permanente Northern California, Division of Research, Oakland; Department of Psychiatry, Henry Ford Health System, Detroit.