title: Patterns of Health Care Usage in the Year Before Suicide: A Population-Based Case-Control Study.
abstract: OBJECTIVE
  To compare the type and frequency of health care visits in the year before suicide between decedents and controls.
  
  
  METHODS
  Cases (n=86) were Olmsted County, Minnesota, residents whose death certificates listed "suicide" as the cause of death from January 1, 2000, through December 31, 2009. Each case had 3 age- and sex-matched controls (n=258). Demographic, diagnostic, and health care usage data were abstracted from medical records. Conditional logistic regression was used to analyze differences in the likelihood of having had psychiatric and nonpsychiatric visits in the year before death, as well as in visit types and frequencies 12 months, 6 months, and 4 weeks before death.
  
  
  RESULTS
  Cases and controls did not significantly differ in having had any health care exposure (P=.18). Suicide decedents, however, had a significantly higher number of total visits in the 12 months, 6 months, and 4 weeks before death (all P<.001), were more likely to have carried psychiatric diagnoses in the previous year (odds ratio [OR], 8.08; 95% CI, 4.31-15.17; P<.001), and were more likely to have had outpatient and inpatient mental health visits (OR, 1.24; 95% CI, 1.05-1.47; P=.01 and OR 6.76; 95% CI, 1.39-32.96; P=.02, respectively). Only cases had had emergency department mental health visits; no control did.
  
  
  CONCLUSIONS
  Given that suicide decedents did not differ from controls in having had any health care exposure in the year before death, the fact alone that decedents saw a doctor provides no useful information about risk. Compared with controls, however, decedents had more visits of all types including psychiatric ones. Higher frequencies of health care contacts were associated with elevated suicide risk.
authors.affiliation: Mayo Medical School, Rochester, MN; Kaiser San Diego, Family Medicine, San Diego, CA.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Chock
authors.affiliation: Mayo Medical School, Rochester, MN.
authors.forename: Tanner J
authors.initials: TJ
authors.lastname: Bommersbach
authors.affiliation: Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Geske
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN. Electronic address: bostwick.john@mayo.edu.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Bostwick
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D016022:Case-Control Studies; D002423:Cause of Death; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008603:Mental Health / Q000706:statistics & numerical data; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data; D000092864:Suicide Prevention