Objective-This study examined rates of contact with primary care and mental health care professionals by individuals before they died by suicide.Method-The authors reviewed 40 studies for which there was information available on rates of health care contact and examined age and gender differences among the subjects.Results-Contact with primary care providers in the time leading up to suicide is common. While three of four suicide victims had contact with primary care providers within the year of suicide, approximately one-third of the suicide victims had contact with mental health services. About one in five suicide victims had contact with mental health services within a month before their suicide. On average, 45% of suicide victims had contact with primary care providers within 1 month of suicide. Older adults had higher rates of contact with primary care providers within 1 month of suicide than younger adults.Conclusions-While it is not known to what degree contact with mental health care and primary care providers can prevent suicide, the majority of individuals who die by suicide do make contact with primary care providers, particularly older adults. Given that this pattern is consistent with overall health-service-seeking, alternate approaches to suicide-prevention efforts may be needed for those less likely to be seen in primary care or mental health specialty care, specifically young men.Suicide is a serious public health problem. Among industrialized countries in 1990, suicide was among the top 10 causes of death (1). In 1998 approximately 30,000 people died by suicide in the United States, making it the eighth leading cause of death (2). Recently, the National Strategy for Suicide Prevention was issued (3), outlining specific goals intended to prevent suicide in the United States. Programs aimed at improving the ability of primary care and mental health professionals to identify and treat those at risk for suicide are recommended. A primary goal of this review was to consider the potential of such strategies. Although general estimates of service contact before suicide are often cited (4, 5), there has been no systematic review of how frequently different types of health care professionals HHS Public Access Author Manuscript Author Manuscript Author ManuscriptAuthor Manuscript have contact with various populations who eventually commit suicide. At least one review has examined contacts with health and mental health care providers before suicide (6); however, its usefulness was limited because it did not take into consideration specific populations that eventually commit suicide, such as older adults or youth, who may differ in their rates of health care contact.Despite limited systematic reviews of health care contacts before suicide, some prevention strategies involving health care providers have been suggested. On the basis of studies of psychological autopsies and record reviews from general practitioner sites, it has been recommended that detecting and treating depression in primary care ...

LDER AMERICANS COMprise about 13% of the US population, yet account for 18% of all suicide deaths. 1 Among adults who attempt suicide, the elderly are most likely to die as a result. 2 Recent national reports emphasize the public health need for intervention trials to reduce the risk for suicide in late life. 3,4 This article presents initial outcomes from the multisite, randomized trial known as PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial). PROSPECT tested the impact of a primary carebased intervention on reducing major risk factors for suicide in late life. Primary care practices were important to study because the majority of older adults who die by suicide have seen their physician within months of their death. 5,6 PROSPECT approached suicide risk reduction from a public health perspective by targeting factors that are strongly related to suicide risk, common in primary care, and malleable. 7 Depression is the principal risk factor for suicide Author Affiliations and Financial Disclosures are listed at the end of this article.

This review examined the available prevalence estimates of suicidality (suicide deaths, attempts, and ideation including thoughts of self harm) in pregnancy and the postpartum. Studies that used defined community or clinic samples were identified through multiple electronic databases and contacts with primary authors. Definitions of and measurement of suicide deaths, intentional self-harming behavior, suicide attempts, and thoughts of death and self-harm were varied and are described with each study. While suicide deaths and attempts are lower during pregnancy and the postpartum than in the general population of women, when deaths do occur, suicides account for up to 20% of postpartum deaths. Self-harm ideation is more common than attempts or deaths, with thoughts of self-harm during pregnancy and the postpartum ranging from 5 to 14%. The risk for suicidality is significantly elevated among depressed women during the perinatal period, and suicide has been found to be the second or leading cause of death in this depressed population.

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Despite the availability of safe and efficacious treatments, mood disorders remain a significant health care issue for the elderly and are associated with disability, functional decline, diminished quality of life, mortality from comorbid medical conditions or suicide, demands on caregivers, and increased service utilization. Discriminatory coverage and reimbursement policies for mental health care are a challenge for the elderly, especially those with modest incomes, and for clinicians. Minorities are particularly underserved. Access to mental health care services for most elderly individuals is inadequate, and coordination of services is lacking. There is an immediate need for collaboration among patients, families, researchers, clinicians, governmental agencies, and third-party payers to improve diagnosis, treatment, and delivery of services for elderly persons with mood disorders.