title: Service utilization by hospitalized suicide attempters with schizophrenia or depression in Montreal.
abstract: OBJECTIVE
  The purpose of this study was to analyze patterns of mental health-related service utilization before and after hospitalization for attempting suicide.
  
  
  METHODS
  This retrospective cohort study included all persons 15 years or older with a clinical diagnosis of schizophrenia (N=195) or depression (N=330) hospitalized in Montreal, Quebec, from April 2003 to December 2004 for attempting suicide. Data on the publicly managed health and social services system were retrieved from the linked administrative databases of Montreal's Health and Social Services Agency (April 2002 to March 2005). Twelve-month preattempt service utilization profile, health care contacts three months pre- and postattempt, and predictors of postattempt service utilization were analyzed for two diagnostic groups (schizophrenia and depression).
  
  
  RESULTS
  Specialized outpatient care and hospital emergency departments were the services most used by both groups before and after attempting suicide. Use of hospital emergency services as a primary care service did not adequately ensure aftercare, whereas prior contact with services and concurrent substance use disorder predicted greater service utilization postattempt among men but not women.
  
  
  CONCLUSIONS
  The publicly managed health and social services system in Montreal seems to respond rather well to severe suicide attempts, including those by men with a concurrent substance use disorder known to be at high suicide risk. However, better coordination among hospital emergency departments, primary care, specialized mental health services, and addiction services is needed in order to enhance continuity of care.
authors.affiliation: Psychosocial Research Division, Douglas Mental Health University Institute, Perry Pavillion E-3311, 6875 LaSalle Blvd, Montreal, Quebec H4H 1R3, Canada. routhier.danielle@gmail.com
authors.forename: Danielle
authors.initials: D
authors.lastname: Routhier
authors.forename: Nicole
authors.initials: N
authors.lastname: Leduc
authors.forename: Alain
authors.initials: A
authors.lastname: Lesage
authors.forename: Mike
authors.initials: M
authors.lastname: Benigeri
mesh_terms: D000293:Adolescent; D000328:Adult; D000359:Aftercare / Q000458:organization & administration / Q000706:statistics & numerical data; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D015897:Comorbidity; D003266:Continuity of Patient Care / Q000458:organization & administration; D003863:Depression / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D012559:Schizophrenia / Q000453:epidemiology*; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D055815:Young Adult