Abstract
Abstract.Background: Healthcare service use among suicide decedents must be well characterized and understood since a key strategy for preventing suicide is to improve healthcare providers' ability to effectively detect and treat those in need. Aims: To determine gender differences in healthcare service use 12 months prior to suicide. Method: Data for 1,231 young Quebec residents (≤ 25 years) who died by suicide between 2000 and 2007 were collected from public health insurance agency databases and coroner registers. Healthcare visits were categorized according to the setting (emergency department [ED], outpatient, and hospital) and their nature (mental health vs. non-mental health). Results: Girls were more likely than boys (82.5% vs. 74.9%, p = .011) to have used healthcare services in the year prior to death. A higher proportion of girls had used outpatient services (79.0% vs. 69.5%, p = .003), had been hospitalized (25.7% vs. 15.6%, p < .001) and had received a mental health-related diagnosis (46.7% vs. 33.1%, p < .001). However, no gender differences were observed in ED visits (59.5% vs. 54.5%, p = .150). Conclusion: There is an important proportion of suicide decedents who did not receive a mental health diagnosis and healthcare services in the year prior to death. Future studies should focus on examining gender-specific individual and health system barriers among suicide decedents as well as the quality of care offered regarding detection and treatment.
References
(2002). Gender issues in youth suicidal behaviour. Emergency Medicine, 14(1), 35–42.
(2003). Suicide and serious suicide attempts in youth: A multiple-group comparison study. American Journal of Psychiatry, 160(6), 1093–1099.
(2008). Suicide rates in young men in England and Wales in the 21st century: Time trend study. British Medical Journal (BMJ), 336(7643), 539–542.
(1993). Psychiatric risk factors for adolescent suicide: A case-control study. Journal of the American Academy of Child and Adolescent Psychiatry, 32(3), 521–529.
(2006). Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry, 47(3-4), 372–394.
(1983). La politique de répartition géographique des effectifs médicaux au Québec [The policy of geographical distribution of Québec's medical staff]. Cahiers québécois de démographie, 12, 1. Retrieved from http://erudit.org/revue/cqd/1983/v12/n1/600491ar.pdf
. (2014). Suicide prevention – youth suicide. Retrieved from http://www.cdc.gov/violenceprevention/pub/youth_suicide.html
(2009). Gender differences in healthcare service utilisation 1 year before suicide: National record linkage study. The British Journal of Psychiatry, 195(5), 459–460.
(2012). Gender and age differences among youth, in utilization of mental health services in the year preceding suicide in Taiwan. Community Mental Health Journal, 48(6), 771–780.
(2005). Comparing the validity of different sources of information on emergency department visits: A latent class analysis. Medical Care, 43(3), 266–275.
(2004). Adolescent suicide in Quebec and prior utilization of medical services. Canadian Journal of Public Health, 95(5), 357–360.
(1997). Youth suicide in Norway, 1990-1992: A comparison between children and adolescents completing suicide and age- and gender-matched controls. Suicide and Life-Threatening Behavior, 27(3), 250–263.
IBM SPSS (Version 22) [Computer software]. Chicago, IL: SPSS Inc.
(2014). Suicide rates in children aged 10-14 years worldwide: Changes in the past two decades. The British Journal of Psychiatry, 205(4), 283–285.
(2005). Concordance between childhood injury diagnoses from two sources: An injury surveillance system and a physician billing claims database. Injury Prevention, 11(3), 186–190.
(2010). Clinical and economic characteristics of patients with fibromyalgia syndrome. Clinical Journal of Pain, 26(4), 284–290.
(2009). Adolescent suicide, gender, and culture: A rate and risk factor analysis. Aggression and Violent Behavior, 14(5), 402–414.
(2014). La mortalité par suicide au Québec: 1981 à 2011: Mise à jour 2014 [Suicide deaths in Quebec 1981–2011: Update 2014]. Québec, Canada: Institut national de santé publique du Québec. Retrieved from http://www.aqps.info/media/documents/Portrait_statistique2014_suicide_Quebec_INSPQ.pdf
(2012). Surveillance des troubles mentaux au Québec: Prévalence, mortalité et profil d'utilisation des services [Monitoring mental disorders in Quebec: prevalence, mortality and service utilization profile]. Québec, Canada: Institut national de santé publique du Québec. Retrieved from http://www.inspq.qc.ca/pdf/publications/1578_SurvTroublesMentauxQc_PrevalMortaProfilUtiliServices.pdf
(1995). The life attitudes schedule: A scale to assess adolescent life-enhancing and life-threatening behaviors. Suicide and Life Threatening Behavior, 25(4), 458–474.
(2012). Suicide in young Singaporeans aged 10-24 years between 2000 to 2004. Archives of Suicide Research, 16(2), 174–182.
(1991). Mental disorders in adolescent suicide. DSM-III-R axes I and II diagnoses in suicides among 13- to 19-year-olds in Finland. Archives of General Psychiatry, 48(9), 834–839.
. (2013). Making the case for investing in mental health in Canada. Retrieved from http://www.mentalhealthcommission.ca/English/system/files/private/document/Investing_in_Mental_Health_FINAL_Version_ENG.pdf
. (2005). Plan d'action en santé mentale 2005-2010 – la force des liens, Ministère de la Santé et des Services sociaux du Québec [Québec's Mental Health Action Plan 2005–2010: the strength of the links. Ministry of Health and Social Services, Québec]. Retrieved from http://publications.msss.gouv.qc.ca/acrobat/f/documentation/2005/05-914-01.pdf
. (2013). Nouvelle classification internationale des maladies et des problèmes de santé connexes (CIM-10) dans les fichiers décès et mortinaissances du Registre des événements démographiques du Québec [New International Classification of Diseases and related health problems (ICD-10) in the files of deaths and stillbirths of the Québec Registry of Demographic Events]. Retrieved from http://www.informa.msss.gouv.qc.ca/Details.aspx?Id=1T0yWy/JOhg=
(2003). The gender gap in suicide and premature death or: Why are men so vulnerable? European Archives of Psychiatry and Clinical Neuroscience, 253(1), 1–8.
(2005). Help-seeking behaviour in men and women with common mental health problems: Cross-sectional study. British Journal of Psychiatry, 186(4), 297–301.
(2014). Surveillance for violent deaths - National Violent Death Reporting System, 16 states, 2010. Morbidity and Mortality Weekly Report (MMWR), Surveillance Summaries, 63(1), 1–33.
(2009). Global patterns of mortality in young people: A systematic analysis of population health data. The Lancet, 374(9693), 881–992. 10.1016/S0140-6736(09)60741-8
(2003). Child and adolescent suicide: Epidemiology, risk factors, and approaches to prevention. Paediatric Drugs, 5(4), 243–265.
(2005). Childhood suicide: A major issue in pediatric health care. Issues in Comprehensive Pediatric Nursing, 28(1), 63–68.
(2011). Young people's recognition of mental disorders and beliefs about treatment and outcome: Findings from an Australian national survey. Australian and New Zealand Journal of Psychiatry, 45(10), 890–898.
. (2014). Health insurance – medical services. Retrieved from http://www.ramq.gouv.qc.ca/en/citizens/health-insurance/healthcare/Pages/medical-services.aspx
(2009). Recent and lifetime utilization of health care services by children and adolescent suicide victims: A case-control study. Journal of Affective Disorders, 117(3), 168–173.
(2014). Service use and unmet needs in youth suicide: A study of trajectories. Canadian Journal of Psychiatry, 59(10), 523–530.
(2013). Sex differences in suicides among children and youth: The potential impact of help-seeking behaviour. The Canadian Journal of Psychiatry, 58(5), 274–282.
(2011). Understanding adolescent and young adult use of family physicians services: A cross-sectional analysis of the Canadian community. BioMed Central Family Practice, 12, 118.
. (2013). Ranking and number of deaths for the 10 leading causes of death by age group, Canada, 2009. Retrieved from http://www.statcan.gc.ca/pub/84-215-x/2012001/table-tableau/tbl003-eng.htm
(2004). L'épidémiologie du suicide au Québec : que savons-nous de la situation récente? [The epidemiology of suicide in Quebec: What do we know about the current situation?]. Québec, QC: Institut national de santé publique du Québec. Retrieved from http://www.inspq.qc.ca/pdf/publications/283-FeuilletEpidemioSuicide.pdf
(2013). Répartition géographique des médecins de famille: Quelles solutions à un problème complexe? [Geographical distribution of family physicians: Which solutions are there for a complex problem?] Santé Publique, 25, 4. Retrieved from http://www.cairn.info/revue-sante-publique-2013-4-page-465.htm
. (2014). Resources help-seeking among men: Implications for suicide prevention. Retrieved from http://www.torontodistresscentre.com/resources/help-seeking-among-men-implications-suicide-prevention
. (2008). Suicide in juveniles and adolescents in the United Kingdom. Journal of Child Psychology and Psychiatry, 49(11), 1155–1165. 10.1111/j.1469-7610.2008.01938.x
. (2012). Public health action for the prevention of suicide. Retrieved from http://www.who.int/mental_health/publications/prevention_suicide_2012/en/index.html
. (2014). Preventing suicide. A global imperative. Retrieved from http://apps.who.int/iris/bitstream/10665/131056/1/9789241564779_eng.pdf?ua=1&ua=1
(2015). A systematic review of the factors associated with delays in medical and psychological help-seeking among men. Health Psychology Review, 9(2), 264–276. 10.1080/17437199.2013.840954
(2001). Factors associated with use of preventive dental and health services among U.S. adolescents. Journal of Adolescent Health Care, 29(6), 395–405.
