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Racial/Ethnic Differences in Health Care Visits Made Before Suicide Attempt Across the United States

Ahmedani, Brian K., PhD, LMSW*; Stewart, Christine, PhD; Simon, Gregory E., MD, MPH; Lynch, Frances, PhD; Lu, Christine Y., PhD§; Waitzfelder, Beth E., PhD; Solberg, Leif I., MD; Owen-Smith, Ashli A., PhD#; Beck, Arne, PhD**; Copeland, Laurel A., PhD††; Hunkeler, Enid M., MA‡‡; Rossom, Rebecca C., MD, MSCR; Williams, Keoki, MD, MPH*

doi: 10.1097/MLR.0000000000000335
Brief Report

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.

*Henry Ford Health System, Center for Health Policy and Health Services Research, Detroit, MI

Group Health Cooperative, Group Health Research Institute, Seattle, WA

Kaiser Permanente Northwest, Center for Health Research, Portland, OR

§Department of Population Medicine and Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA

Kaiser Permanente Hawaii, Center for Health Research, Honolulu, HI

HealthPartners, Institute for Education and Research, Bloomington, MN

#Kaiser Permanente Georgia, Center for Health Research, Atlanta, GA

**Kaiser Permanente Colorado, Institute for Health Research, Denver, CO

††Baylor Scott & White Health, Center for Applied Health Research, Temple, TX

‡‡Kaiser Permanente Northern California, Division of Research, Oakland, CA

Supported by Award Number U19MH092201 from the National Institute of Mental Health.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.

Reprints: Brian K. Ahmedani, PhD, LMSW, Henry Ford Health System, Center for Health Policy and Health Services Research, 1 Ford Place, Suite 3A, Detroit, MI 48202. E-mail:

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