Abstract
Objective
To compare health care usage between suicide decedents and living controls in the
year before suicide in a large representative US population.
Patients and Methods
Cases (n=1221) and controls (n=3663) belonged to an integrated health care system
from January 1, 2009, through December 31, 2014. Cases and controls were matched for
age and sex in a 1:3 ratio, with diagnostic and/or billing codes used to enumerate
and classify health care visits in the year before the index suicide. Matched analysis
via conditional logistic regression related odds of suicide to visit type. A generalized
estimating equation model was used to compare timing and frequency of visits between
cases and controls.
Results
In the year before death, cases had an increased odds of both inpatient hospitalizations
and emergency department nonmental health visits (odds ratio [OR], 1.55; 95% CI, 1.27-1.88;
P<.001 and OR, 1.42; 95% CI, 1.26-1.60; P<.001) but not outpatient nonmental health visits (OR, 1.00; 95% CI, 0.99-1.01; P=.63). Decedents increased health care utilization closer to suicide death and had
significantly more health care visits than did controls 3 months before suicide (6
vs 2; P=.01) but not 9 to 12 months before suicide (4 vs 2; P=.07). At all time points, cases used more mental health care services than did controls.
Conclusion
Compared with controls, suicide decedents had emergency department visits and more
inpatient hospitalizations, both mental health and nonmental health related. As death
approached, cases' frequency of health care usage increased. The only category in
which cases and controls did not differ was in the frequency of outpatient nonmental
health visits.
Abbreviations and Acronyms:
ED (emergency department), EMR (electronic medical record), ICD-9 (International Classification of Diseases, Ninth Revision), ICD-10 (International Classification of Diseases, Tenth Revision), OR (odds ratio)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: August 16, 2019
Footnotes
For Limelight, see page 1915
Dr Chock is now with Kaiser Permanente, Honolulu, HI.
Grant Support: The study was funded by a Kaiser Permanente Southern California Regional Research Committee grant, which is partially supported by the Southern California Permanente Medical Group Research and Evaluation Department and Direct Community Benefit Investment funds. Researchers were independent of study funders.
Potential Competing Interests: The authors report no competing interests.
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© 2019 Mayo Foundation for Medical Education and Research
