Contact With Mental Health Services Prior to Suicide: A Systematic Review and Meta-Analysis

Objective: Access to mental health care is regarded as a central suicide prevention strategy. This is the first systematic review and meta-analysis of the prevalence of contact with mental health services preceding suicide. Methods: A systematic search for articles reporting prevalence of contact with mental health services before suicide was conducted in MEDLINE and PsycINFO, restricted to studies published from January 1, 2000, to January 12, 2017. A random-effects meta-analysis with double arcsine transformations was conducted, with meta-regression used to explore heterogeneity. Results: Thirty-five studies were included in the systematic review, and 20 were included in the meta-analysis. Among suicide decedents in the population, 3.7% (95% confidence interval [CI]=2.6% 24.8%) were inpatients at the time of death. In the year before death, 18.3% (CI=14.6% 222.4%) of suicide decedents had contact with inpatient mental health services, 26.1% (CI=16.5% 237.0%) had contact with outpatient mental health services, and 25.7% (CI=22.7% 228.9%) had contact with inpatient or outpatient mental health services. Meta-regression showed that women had significantly higher levels of contact compared with men and that the prevalence of contact with inpatient or outpatient services increased according to the sample year. Conclusions: Contact with services prior to suicide was found to be common and contact with inpatient or outpatient mental health services before suicide seems to be increasing. However, the reviewed studies were mainly conducted in Western European and North American countries, and most studies focused on psychiatric hospitalization, which resulted in limited data on contact with outpatient services. Better monitoring and data on suicides that occur during and after treatment seem warranted.