• Science Update
Undetected suicide risk is a critical issue in primary care. According to a NIMH-funded study published in the February 2014 issue of the Journal of General Internal Medicine, 83 percent of individuals received health care services in the year prior to suicide death and half did not have a mental health diagnosis.
In 2010, over 38,000 American lives were lost to suicide, according to the Centers for Disease Control and Prevention . This rate is twice the homicide rate and higher than the annual number of traffic fatalities.
To reduce this alarming rate, a major public – private initiative, the National Action Alliance for Suicide Prevention was developed to help advance the National Strategy for Suicide Prevention . The National Strategy is a call to action for guiding suicide prevention actions in the U.S. over the next decade. As part of this strategy, NIMH is on a research task force that recently released A Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives. The stated goal of the Research Agenda is to reduce suicides by 20 percent in the next five years and 40 percent in the next ten.
There has been a lack of U.S. population data available on the health care services individuals receive prior to suicide. Such outcome data is necessary to determine what care practices need to be added and/or changed to reduce suicide risk among the patients served. Researchers from eight different health systems of the Mental Health Research Network (MHRN), which serve over 11 million individuals across diverse U.S. populations, conducted a study of suicide and health services utilization. This longitudinal study from 2000 to 2010, involved 5,894 individuals who sought health services in the year before suicide death.
Results of This Study
This study shows that the majority of people who died by suicide received health care services in the year prior to death—half made a medical visit within four weeks. The most common visit types included primary care and medical specialty. The individuals who made these visits were mostly older adults, specifically women.
The study also found that over half of individuals did not have a mental health diagnosis in the year before death. In the four weeks before death, about 75 percent did not have a mental health diagnosis. A mental health diagnosis was even less common among disadvantaged groups with lower levels of education and income.
The findings indicate that there is a key opportunity to reach individuals at risk for suicide within primary care and medical specialty settings. “We’re at a point now where we have a lot of information that we’ve never had before. Reducing suicide is possible and the health care system is a great place to start,” said study author Brian K. Ahmedani, Ph.D., at the Center for Health Policy and Health Services Research, Henry Ford Health System. In primary care, physicians may be able to detect risk and begin treatment earlier to prevent suicides.
Many primary care providers have begun screening for depression, alcohol, and drug use. However, suicide screening is not common across all health systems. “Primary care providers are very busy, but asking one more question about suicide is definitely possible since many places are already screening for other conditions like depression,” said Ahmedani.
More research is needed to improve health care processes and workflows for screening, assessing, treating, and referring patients. Training and support may be needed for health care providers to identify and treat individuals at risk for suicide and other mental health conditions.
This study provides important information for attaining the National Strategy’s goal to reduce suicides by 20 percent in the next five years.
Ahmedani BK, Simon GE, Stewart C, Beck A, Waitzfelder BE, Rossom R, Lynch F, Owen-Smith A, Hunkeler EM, Whiteside U, Operskalski BH, Coffey MJ, Solberg LI. Health Care Contacts in the Year Before Suicide Death. Journal of General Internal Medicine , published online February 25, 2014.