title: An observational study of the impact of service use on suicidality among adults with mental disorders.
abstract: BACKGROUND
  It is unclear whether treatment of mental disorders reduces the probability that a) people without suicidal ideation will begin to contemplate suicide, or b) people who have thought about killing themselves (but have not attempted suicide) will go on to make an attempt.
  
  
  METHODS
  Mental disorders, service use for emotional or substance use problems, and suicidality were assessed using the World Mental Health version of the Composite International Diagnostic Interview. Discrete-time survival analysis was used to establish the temporal priority of mental health service use and suicide-related outcomes among the 5,862 participants in the Collaborative Psychiatric Epidemiological Surveys who reported a mental disorder.
  
  
  RESULTS
  Use of specialty mental health services, but not other types of services for emotional or substance use problems, was associated with an increased risk of future suicide ideation (OR = 1.27, CI = 1.01-1.60). However, respondents with a history of suicidal ideation were less likely to report a subsequent suicide attempt if they had received any type of service for emotional or substance use problems (OR = 0.62, CI = 0.46-0.83), regardless of the type of service received (i.e., it did not matter whether the service received was mental health care, general medical care, or non-health care related).
  
  
  CONCLUSIONS
  Among persons with frank DSM disorders and suicidal ideation, the receipt of treatment is associated with a lower rate of subsequent suicide attempts, compared with those who never received treatment, regardless of treatment provider type. Follow-up studies are a logical next step to our observational investigation.
authors.affiliation: National Institute of Psychiatry, Calzada México Xochimilco 101, Mexico City, Mexico.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Borges
authors.affiliation: National Institute of Psychiatry, Calzada México Xochimilco 101, Mexico City, Mexico.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Orozco
authors.affiliation: RAND Corporation, Pittsburgh, PA, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Breslau
authors.affiliation: Director, Undergraduate Program in Health Sciences, Northeastern University, Bouvé College of Health Sciences, Department of Health Sciences, Room 316 Robinson Hall, 360 Huntington Avenue, Boston, MA, 02115-5000, USA. ma.miller@neu.edu.|Director, Harvard Injury Control Research Center, Adjunct Professor of Epidemiology, Harvard School of Public Health, Boston, MA, USA. ma.miller@neu.edu.
authors.forename: Matthew
authors.initials: M
authors.lastname: Miller
keywords: Mental disorders; Mental health service; Suicidal attempts; Suicidal ideation; Suicidality; Treatment