Background: Suicide rates among adolescents have risen steadily since 2007, creating a dire need to expand prevention protocols. Health care visits have been identified as key opportunities for identification and intervention. To date, studies of youth and young adult health conditions and service utilization have been limited by small or circumscribed samples.
Methods: A case-control study was conducted using records from 9 health systems nationwide. Data from 450 members, 10–24 years of age, who died by suicide between the years 2000 and 2015 were matched with data from 4500 controls based on health system and time period of membership. We examined past-year recorded diagnoses, patterns of visit types, and frequency of those visits.
Results: Adolescents who died by suicide were more likely to have at least one recorded mental health diagnosis (51% vs 16%; adjusted odds ratio: 5.74, 95% CI: 4.60–7.18) and higher rates of each individual mental health condition except for autism. Adjusting for age and gender, odds ratios ranged from 2.85 (ADHD) to more than 16 (eating disorders, other psychoses). Recorded diagnoses of brain injuries, epilepsy, and sleep disorders also were more likely among cases. Close to half (49%) and nearly all (89%) youth who died by suicide had a health care visit in the month and year prior to their death, respectively. Across all visit types and time frames (30, 90, and 365 days), cases were more likely to visit the health system than controls. Visits for outpatient specialty care were most common in the past year, with suicide decedents making an average of 8 visits in the year before death, only 4 of which were associated with a recorded mental health diagnosis.
Conclusion: With nearly half (49%) of adolescents who died by suicide lacking a recorded mental health diagnosis in the year prior to their death, relying only on mental health services to identify at-risk adolescents may not be sufficient. High rates of health care utilization among those who died by suicide indicate a strong need for improving identification of youth while they are seeking services, thereby preventing future deaths.