title: Health care contacts in the year before suicide death.
abstract: 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.
  
  
  METHODS
  Longitudinal study from 2000 to 2010 within eight Mental Health Research Network health care systems serving eight states.
  
  
  METHODS
  In all, 5,894 individuals who died by suicide, and were health plan members in the year before death.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Center for Health Policy and Health Services Research, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA, bahmeda1@hfhs.org.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Ahmedani
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Simon
authors.forename: Christine
authors.initials: C
authors.lastname: Stewart
authors.forename: Arne
authors.initials: A
authors.lastname: Beck
authors.forename: Beth E
authors.initials: BE
authors.lastname: Waitzfelder
authors.forename: Rebecca
authors.initials: R
authors.lastname: Rossom
authors.forename: Frances
authors.initials: F
authors.lastname: Lynch
authors.forename: Ashli
authors.initials: A
authors.lastname: Owen-Smith
authors.forename: Enid M
authors.initials: EM
authors.lastname: Hunkeler
authors.forename: Ursula
authors.initials: U
authors.lastname: Whiteside
authors.forename: Belinda H
authors.initials: BH
authors.lastname: Operskalski
authors.forename: M Justin
authors.initials: MJ
authors.lastname: Coffey
authors.forename: Leif I
authors.initials: LI
authors.lastname: Solberg
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002648:Child; D003695:Delivery of Health Care / Q000458:organization & administration; D003951:Diagnostic Errors / Q000517:prevention & control*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008501:Medical Records, Problem-Oriented / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology; D008603:Mental Health; D020380:Needs Assessment; D011314:Preventive Health Services / Q000379:methods / Q000592:standards; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D000092864:Suicide Prevention