DETROIT – Nearly all U.S. suicide attempts are preceded by a healthcare visit during the prior year, and there are significant racial differences in the types and timing of those visits.
Those are among the findings of a nationwide study of data from 10 healthcare institutions, including Henry Ford Health System, intended to inform ongoing suicide prevention efforts by identifying those at risk.
It is the largest U.S. study of racial or ethnic differences in the types and timing of healthcare encounters made before a suicide attempt. The study in the May issue of Medical Care, a peer-reviewed journal published by Wolters Kluwer.
“More than a million people attempt suicide each year in the United States, and among adults the rate of completed suicides has grown by 30 percent over the last decade,” says Henry Ford researcher Brian Ahmedani, Ph.D., the study’s lead author.
“These were among the reasons the Department of Health and Human Services recently made suicide a priority in publishing a National Strategy for Suicide Prevention. It concluded that one of the best places to prevent suicide is within healthcare.”
Working with data collected from the 10 healthcare systems – all members of the National Institute of Mental Health-funded Mental Health Research Network – the researchers identified 22,387 people who had attempted suicide from January 2009 to December 2011. All were enrolled in health plans.
Of those, about 78 percent – 17,428 individuals – were self-identified by race or ethnicity, including Alaskan Native/Native American, Asian, black, Hispanic, Hawaiian/Pacific Islander and white. Those without such identification, or who were of mixed race or ethnicity, were excluded from the study.
Overall, a 54-percent majority of the patients were white, some 65 percent were female, 30 percent younger than 20, 33 percent ages 20-39, 30 percent ages 40-64, and 6 percent age 65 or older.
Among them, almost 95 percent made any healthcare visit within a year before their suicide attempts, more than 38 percent within a week, and almost 64 percent within four weeks.
One-quarter of them made a visit with a mental health diagnosis within one week, almost 44 percent within four weeks, and more than 73 percent within 52 weeks of their attempt.
In analyzing patterns by race or ethnicity, the researchers found:
- More than 41 percent of whites made any visit within one week of their attempt compared to less than 35 percent for other groups.
- Nearly 27 percent of whites made a mental health visit, versus less than 20 percent of Asian, Hawaiian/Pacific Islander and black individuals within a week.
- Within four weeks, all visits and mental health visits remained most common for whites and least common among Asians.
- Alaskan Natives/Native Americans and whites made mental health visits 10-25 percent more often than other groups.
- More than 31 percent of whites and 27 percent of Alaskan Natives/Native Americans had an inpatient stay with a mental health diagnosis within 52 weeks of a suicide attempt, compared to less than 11 percent of Hawaiian/Pacific Islanders
- In contrast, Hawaiian/Pacific Islanders were most likely to have an inpatient stay without a mental health or substance use diagnosis
In addition, emergency department visits with mental health and substance use diagnoses were most common among Alaskan Natives/Native Americans and whites, and the proportion of Asians with the same types of visits was much lower. Emergency visits by Asians without psychiatric diagnoses were also the least common.
Primary care visits with mental health and other diagnoses were most common among whites, visits with substance use diagnoses were most common among Alaskan Natives/Native Americans, and the proportion of those patients who made primary care visits with substance use and mental health diagnoses was lowest among Hawaiian/Pacific Islanders and Asians.
“Even though the vast majority of patients made visits within a year of a suicide attempt, whites tended to make visits closer to the date of their attempt,” Ahmedani explains. “This supports evidence that whites are more likely to access and engage in health care throughout the year.
“There may be a great opportunity to prevent suicide right before it happens within this population. And while there’s still an opportunity to intervene with those of other races or ethnicities during healthcare visits, the lower proportion of visits suggests that it’s important to also find other opportunities for prevention.”
Although the authors acknowledge limitations to the study, first among them that it is likely not all suicide attempts were included in the data since not everyone who makes an attempt receives healthcare afterward, the findings “highlight the importance of considering sociocultural differences when attempting to assess risk and prevent suicide.”
Earlier research led by Ahmedani and published in early 2014 found that mental health conditions in most people who commit suicide remain undiagnosed, even though most visit a primary care doctor or specialist within the year before they die.
It concluded that to help prevent suicides, healthcare providers should be more attuned to the state of their patients’ mental health and possible suicidal thoughts.
Funding: National Institute of Mental Health (Grant # U19MH092201)