Racial/Ethnic differences in health care visits made before suicide attempt across the United States

Abstract

Background: Suicide is a public health concern, but little is known about the patterns of health care visits made before a suicide attempt, and whether those patterns differ by race/ethnicity.

Objectives: To examine racial/ethnic variation in the types of health care visits made before a suicide attempt, when those visits occur, and whether mental health or substance use diagnoses were documented.

Research design: Retrospective, longitudinal study, 2009-2011.

Participants: 22,387 individuals who attempted suicide and were enrolled in the health plan across 10 health systems in the Mental Health Research Network.

Measures: Cumulative percentage of different types of health care visits made in the 52 weeks before a suicide attempt, by self-reported racial/ethnicity and diagnosis. Data were from the Virtual Data Warehouse at each site.

Results: Over 38% of the individuals made any health care visit within the week before their suicide attempt and ∼95% within the preceding year; these percentages varied across racial/ethnic groups (P<0.001). White individuals had the highest percentage of visits (>41%) within 1 week of suicide attempt. Asian Americans were the least likely to make visits within 52 weeks. Hawaiian/Pacific Islanders had proportionally the most inpatient and emergency visits before an attempt, but were least likely to have a recorded mental health or substance use diagnosis. Overall, visits were most common in primary care and outpatient general medical settings.

Conclusions: This study provides temporal evidence of racial/ethnic differences in health care visits made before suicide attempt. Health care systems can use this information to help focus the design and implementation of their suicide prevention initiatives.

Figure 1. Cumulative proportion of individuals who had inpatient hospital stays prior to suicide attempt

Aggregated data on inpatient hospital stays across 10 Mental Health Research Network affiliated health systems serving 13 US states are presented in 52 weekly increments prior to each suicide attempt. Data are from individuals who attempted suicide from 2009 thru 2011 and are stratified by racial/ethnicity and diagnosis recorded at the visit (mental health, substance use, other).

Figure 2. Cumulative proportion of individuals who made emergency department visits prior to suicide attempt

Aggregated data on emergency department visits across 10 Mental Health Research Network affiliated health systems serving 13 US states are presented in 52 weekly increments prior to each suicide attempt. Data are from individuals who attempted suicide from 2009 thru 2011 and are stratified by racial/ethnicity and diagnosis recorded at the visit (mental health, substance use, other).

Figure 3. Cumulative proportion of individuals who made primary care visits prior to suicide attempt

Aggregated data on primary care visits across 10 Mental Health Research Network affiliated health systems serving 13 US states are presented in 52 weekly increments prior to each suicide attempt. Data are from individuals who attempted suicide from 2009 thru 2011 and are stratified by racial/ethnicity and diagnosis recorded at the visit (mental health, substance use, other).

Figure 4. Cumulative proportion of individuals who made outpatient specialty visits prior to suicide attempt

Aggregated data on outpatient specialty visits across 10 Mental Health Research Network affiliated health systems serving 13 US states are presented in 52 weekly increments prior to each suicide attempt. Data are from individuals who attempted suicide from 2009 thru 2011 and are stratified by racial/ethnicity and diagnosis recorded at the visit (mental health, substance use, other).