Health care contact and suicide risk documentation prior to suicide death: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).
OBJECTIVE
Prior research has shown that a substantial portion of suicide decedents access health care in the weeks and months before their death. We examined whether this is true among soldiers.


METHODS
The sample included the 569 Regular Army soldiers in the U.S. Army who died by suicide on active duty between 2004 and 2009 compared to 5,690 matched controls. Analyses examined the prevalence and frequency of health care contacts and documentation of suicide risk (i.e., the presence of prior suicidal thoughts and behaviors) over the year preceding suicide death. Predictors of health care contact and suicide risk documentation were also examined.


RESULTS
Approximately 50% of suicide decedents accessed health care in the month prior to their death, and over 25% of suicide decedents accessed health care in the week prior to their death. Mental health encounters were significantly more prevalent among suicide decedents (4 weeks: 27.9% vs. 7.9%, χ2 = 96.2, p < .001; 52 weeks: 59.4% vs. 33.7%, χ2 = 120.2, p < .001). Despite this, risk documentation was rare among suicide decedents (4 weeks: 13.8%; 52 weeks: 24.5%). Suicide decedents who were male, never married, and non-Hispanic Black were less likely to access care prior to death. Number of mental health encounters was the only predictor of suicide risk documentation among decedents at 4 weeks (OR = 1.14) and 52 weeks (OR = 1.05) prior to their death.


CONCLUSIONS
Many soldiers who die by suicide access health care shortly before death, presenting an opportunity for suicide prevention. However, in most cases, there was no documentation of prior suicidal thoughts or behaviors, highlighting the need for improvements in risk detection and prediction. Increasing the frequency, scope, and accuracy of risk assessments, especially in mental health care settings, may be particularly useful. (PsycINFO Database Record
Department of Psychology, Florida State University.
Jessica D
JD
Ribeiro
Department of Psychiatry, University of Colorado School of Medicine.
Peter M
PM
Gutierrez
Department of Psychology, Florida State University.
Thomas E
TE
Joiner
Department of Health Care Policy, Harvard Medical School.
Ronald C
RC
Kessler
Department of Health Care Policy, Harvard Medical School.
Maria V
MV
Petukhova
Department of Health Care Policy, Harvard Medical School.
Nancy A
NA
Sampson
University of California, San Diego.
Murray B
MB
Stein
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences.
Robert J
RJ
Ursano
Department of Psychology, Harvard University.
Matthew K
MK
Nock
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D055500:Resilience, Psychological; D018570:Risk Assessment / Q000706:statistics & numerical data*; D013405:Suicide / Q000706:statistics & numerical data*; D014481:United States