title: Primary health care utilization prior to suicide: a retrospective case-control study among active-duty military personnel.
abstract: OBJECTIVE
  About 45% of civilians who died by suicide had contact with a doctor within 1 month of death. Thus, educating primary care physicians (PCP) to detect and mitigate depression is an important suicide-prevention strategy. However, the PCP consulting rate before suicide has not been examined in a military population. We investigated the utilization of primary health care and mental health services by active-duty military personnel suicide cases prior to death in comparison to matched military controls.
  
  
  METHODS
  All suicides (N = 170) were extracted from a cohort of all active-duty Israeli military male personnel between 2002 and 2012. Applying a retrospective, nested case-control design, we compared primary care services utilization by suicide cases with demographic and occupationally matched military controls (N = 500).
  
  
  RESULTS
  Whereas 38.3% of suicide cases contacted a PCP within the last month before death, only 27.6% of suicide cases contacted a mental health specialist during their entire service time. The PCP contact rate within 1 month before death or index day did not differ between suicide cases and military controls (38.3% vs. 33.8%, χ²₁ = 1.05, P = .3). More suicide cases contacted a mental health specialist within service time than did military controls (27.6% vs. 13.6%, χ²₁ = 10.85, P = .001).
  
  
  CONCLUSIONS
  Even though PCP contact rate by military personnel who died by suicide is slightly lower than that reported for civilians who died by suicide prior to their death, it is higher than mental health specialist contact rate and higher than that by age-matched civilians who died by suicide. These results imply that PCPs education is a viable approach to suicide prevention in a military setting.
authors.affiliation: Geha Mental Health Center, PO Box 103, Petach-Tikva, 49100 Israel hochmaneldar@gmail.com.
authors.forename: Eldar
authors.initials: E
authors.lastname: Hochman
authors.forename: Leah
authors.initials: L
authors.lastname: Shelef
authors.forename: J John
authors.initials: JJ
authors.lastname: Mann
authors.forename: Shirly
authors.initials: S
authors.lastname: Portugese
authors.forename: Amir
authors.initials: A
authors.lastname: Krivoy
authors.forename: Gal
authors.initials: G
authors.lastname: Shoval
authors.forename: Mark
authors.initials: M
authors.lastname: Weiser
authors.forename: Eyal
authors.initials: E
authors.lastname: Fruchter
mesh_terms: D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008889:Military Personnel / Q000523:psychology*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013405:Suicide; D055815:Young Adult