Recent medical service utilization and health conditions associated with a history of suicide attempts.
OBJECTIVE
Suicide is a leading cause of death; unfortunately most individuals at risk for suicide are not identified, assessed or treated by the mental health system. Investigating medical healthcare utilization among individuals with a history of suicide attempt may identify alternative settings for case finding and brief intervention.


METHODS
The study sample (n=1422, 58% female, 72% African-American) is from a prospective cohort of adults (27-31 years) who participated in a randomized trial of school-based interventions. Logistic regression evaluated the relationship between lifetime history of suicide attempt with past year medical service utilization and selected self- reported health conditions, controlling for lifetime Major Depressive Disorder (MDD), demographic factors, health insurance status and employment.


RESULTS
A suicide attempt history was associated with past year emergency department medical visits [aOR 1.51, 95% CI 1.04-2.18, P=.03], but not primary care visits or inpatient hospitalization, when controlling for MDD and other covariates. Severe headaches and chronic gastrointestinal conditions were also associated with lifetime suicide attempt [aOR 1.50, 95% CI 1.03-2.17 and aOR 1.67, 95% CI 1.06-2.63, respectively].


CONCLUSIONS
Suicide prevention, including universal screening and brief intervention, is indicated in emergency department settings. Restricting screening to subgroups, such as those individuals presenting with depression, may miss at-risk individuals with somatic concerns.
Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
Elizabeth D
ED
Ballard
Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Mary
M
Cwik
Department of Family & Community Health, University of Maryland School of Nursing, Baltimore, MD, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Carla L
CL
Storr
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Mitchell
M
Goldstein
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
William W
WW
Eaton
Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: hwilcox1@jhmi.edu.
Holly C
HC
Wilcox
D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology*; D006261:Headache / Q000453:epidemiology*; D006801:Humans; D008297:Male; D013406:Suicide, Attempted / Q000706:statistics & numerical data*
Depression; Emergency department; Suicide