Health Care Use Preceding Suicide by Firearm Compared with Suicide by Other Means - Alaska, Colorado, and Washington, 2020-2022.

Firearms are the most common means of suicide in the United States and a leading cause of death among all persons aged 10-64 years. Most persons who die by suicide see a clinician in the year preceding their death; thus, health care encounters are important opportunities for suicide prevention. Persons who die by firearm suicide differ demographically and clinically from those who die by other suicide means, suggesting that opportunities for prevention might also differ between these groups. This report examined patterns of health care use in the year preceding suicide death to identify potential opportunities for prevention among persons who died by firearm suicide and those who died by other means of suicide. State cause-of-death records for 2020-2022 were linked to electronic health records from health systems in Alaska (Southcentral Foundation) and Colorado and Washington (both Kaiser Permanente). Quarterly past-year health care use preceding death was examined across service settings, including primary care, outpatient mental health specialty care, emergency care, and inpatient care. During 2020-2022, across the three health systems, 683 persons died by suicide. The majority of these deaths (54.6%) occurred by firearm. Patterns of past-year health care use preceding suicide were similar for persons who died by firearm and other suicide means, with the exception of mental health care, which was significantly lower in specialty and primary care settings. These findings suggest that many persons who die by firearm suicide do not access mental health care before their death. Suicide prevention practices in health care, designed to help identify and engage persons at risk in supportive care, need to reach beyond mental health encounters, particularly for firearm suicide prevention.