摘要：Objectives. We examined mental health treatment patterns among adults with suicide attempts in the past 12 months in the United States. Methods. We examined data from 2000 persons, aged 18 years or older, who participated in the 2008 to 2012 National Survey on Drug Use and Health and who reported attempting suicide in the past 12 months. We applied descriptive analyses and multivariable logistic regression models. Results. In adults who attempted suicide in the past year, 56.3% received mental health treatment, but half of those who received treatment perceived unmet treatment needs, and of the 43.0% who did not receive mental health treatment, one fourth perceived unmet treatment needs. From 2008 to 2012, the mental health treatment rate among suicide attempters remained unchanged. Factors associated with receipt of mental health treatment varied by perceived unmet treatment need and receipt of medical attention that resulted from a suicide attempt. Conclusions. Suicide prevention strategies that focus on suicide attempters are needed to increase their access to mental health treatments that meet their needs. To be effective, these strategies need to account for language and cultural differences and barriers to financial and treatment delivery. More than 38 000 deaths were by suicide in the United States in 2010. 1,2 A suicide attempt history is the strongest known clinical predictor for death by suicide. 3,4 In 2012, more than 1.3 million adults aged 18 years or older (0.6%) reported that they attempted suicide in the past year. 5 Mental health treatment could play a critical role in reducing suicide risk among suicide attempters. 3,6–8 Promising interventions for people who attempt suicide have been developed over the past decade. 6 However, many suicide attempters do not receive mental health treatment. Approximately 40% of previous 12-month suicide attempters did not receive mental health treatment in the United States in 2001 to 2003 9 and 2008 to 2009. 10 Even in Canada, which has 1 national health care system and universal insurance coverage, approximately 40% of past 12-month suicide attempters did not receive mental health treatment in 2002. 11 Thus, it is crucial to better understand mental health treatment patterns among past 12-month suicide attempters. A few studies in the United States 9,12,13 and 1 in Canada 11 estimated mental health treatment rates among past 12-month suicide attempters. However, none of the existing studies examined the intensity of outpatient mental health visits and the length of stay of inpatient psychiatric treatment received by adults with recent suicide attempts in the United States. Moreover, little is known about barriers to mental health treatment in this high-risk group. Little is known about the mental health treatment patterns among suicide attempters who received medical attention that resulted from a suicide attempt. A recent study indicated that an adverse physical health event increases mental health treatment among community-dwelling adults, 14 but the applicability of this finding to adult suicide attempters is uncertain. None of the existing studies have examined whether chronic physical health conditions (e.g., heart disease, hypertension, asthma, and diabetes), emergency room (ER) visits, and receipt of medical attention resulting from a suicide attempt affected the receipt of mental health treatment among adult suicide attempters. It is unknown whether and how characteristics associated with receiving mental health treatment among suicide attempters varied by their perceived unmet treatment needs and by whether they received medical attention resulting from a suicide attempt. Although substance use disorders (SUDs) increase the risk of suicide attempts, 15,16 it is unknown whether SUDs influence receipt of mental health treatment among adult suicide attempters. Little is known about the association between the receipt of substance use treatment and receipt of mental health treatment among adult suicide attempters. Although recent involvement with the criminal justice system elevates the risk of suicide attempts, 17 none of the existing studies have examined whether the number of times a person was arrested or booked affected receipt of mental health treatment among suicide attempters. In addition, none of the existing studies examined trends in mental health treatment rates among adult suicide attempters over the past 5 years. Finally, because approximately 60% of adults with past-year suicide attempts received mental health treatment in the past 12 months, the results from the existing studies 11,13 on the factors associated with receipt of mental health treatment, which are based on odds ratios rather than risk ratios, might overestimate association magnitudes. 18–21 Thus, using recent nationally representative data, we examined the following understudied questions: What was the intensity of mental health treatment received by adults who had past 12-month suicide attempts? What were the prevalence and correlates of receiving mental health treatment in the past 12 months among this population? Did characteristics associated with receiving mental health treatment among adults with past 12-month suicide attempts vary by their perceived unmet treatment needs and receipt of medical attention resulting from a suicide attempt? Were there trends in mental health treatment rates among this population from 2008 to 2012? What were the self-reported reasons for not receiving mental health treatment by adult suicide attempters with perceived unmet treatment needs? Addressing these gaps in knowledge could help develop effective suicide prevention, promote mental health treatment among adult suicide attempters, and reduce their overall risk of death by suicide.
