Who didn't consult the doctor? Understanding sociodemographic factors in relation to health care uptake before suicide

Objective: This study aimed to establish differences between suicide decedents and a reference population across various health care settings. Methods: This population-wide registration study combined death statistics, sociodemographic data and health care data from Statistics Netherlands. From 2010 to 2016, 12,015 suicide cases and a random reference group of 132,504 were included and assigned to one of the three health care settings; mental health (MH) care, primary care or no care. Logistic regression analyses were performed to determine differences in suicide risk factors across settings. Results: In the 1?2 year period before suicide, 52% of the suicide decedents received MH care, 41% received GP care only and 7% received neither. Although sociodemographic factors showed significant differences across settings, the suicide risk profiles were not profoundly distinctive. A decreasing trend in suicide risk across health care settings became apparent for male gender, income level and being in a one-person or one-parent household, whereas for other factors (middle and older age, non-Western migration background, couples without children and people living in more sparsely populated areas), risk of suicide increased when health care setting became more specialized. Limitations: Because of the data structure, 18 months of suicide decedents? health care use were compared with two years health care use of the reference group, which likely led to an underestimation of the reported differences. Conclusion: Although there are differences between suicide decedents and a reference group across health care settings, these are not sufficiently distinctive to advocate for a setting-specific approach to suicide prevention.