Healthcare contact and suicide risk documentation prior to suicide deaths: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

Objective—Prior research has shown that a substantial portion of suicide decedents access healthcare in the weeks and months before their death. We examined whether this is true amongsoldiers.
Method—The sample included the 569 Regular Army soldiers in the U.S. Army who died by suicide on active duty between 2004–2009 compared to 5,690 matched controls. Analyses examined the prevalence and frequency of healthcare contacts and documentation of suicide risk (i.e., the presence of prior suicidal thoughts and behaviors) over the year preceding suicide death. Predictors of healthcare contact and suicide risk documentation also were examined.
Results—Approximately 50% of suicide decedents accessed healthcare in the month prior to their death and over 25% in the week prior to death. Mental health encounters were significantly more prevalent among suicide decedents (4-weeks: 27.9% vs. 7.9%. χ2=96.2, p<.001; 52-weeks: 59.4% vs. 33.7%, χ2=120.2, p<.001). Despite this, risk documentation was rare among suicide decedents (4-weeks: 13.8%; 52-weeks: 24.5%). Suicide decedents who were male, never married, encounters was the only predictor of suicide risk documentation among decedents at 4-weeks (OR: 1.14) and 52-weeks (1.05) prior to their death.
Conclusions—Many soldiers who die by suicide contact healthcare shortly before death, presenting an opportunity for suicide prevention. However, in most cases there was no documentation of prior suicidal thoughts or behaviors, highlighting the need for improvements in risk detection and prediction. Increasing the frequency, scope, and accuracy of risk assessments, especially in mental healthcare settings, may be particularly useful.