An observational study of the impact of service use on suicidality among adults with mental disorders

BACKGROUND It is unclear whether treatment of mental disorders reduces the probability that a) people without suicidal ideation will begin to contemplate suicide, or b) people who have thought about killing themselves (but have not attempted suicide) will go on to make an attempt. METHODS Mental disorders, service use for emotional or substance use problems, and suicidality were assessed using the World Mental Health version of the Composite International Diagnostic Interview. Discrete-time survival analysis was used to establish the temporal priority of mental health service use and suicide-related outcomes among the 5,862 participants in the Collaborative Psychiatric Epidemiological Surveys who reported a mental disorder. RESULTS Use of specialty mental health services, but not other types of services for emotional or substance use problems, was associated with an increased risk of future suicide ideation (OR = 1.27, CI = 1.01-1.60). However, respondents with a history of suicidal ideation were less likely to report a subsequent suicide attempt if they had received any type of service for emotional or substance use problems (OR = 0.62, CI = 0.46-0.83), regardless of the type of service received (i.e., it did not matter whether the service received was mental health care, general medical care, or non-health care related). CONCLUSIONS Among persons with frank DSM disorders and suicidal ideation, the receipt of treatment is associated with a lower rate of subsequent suicide attempts, compared with those who never received treatment, regardless of treatment provider type. Follow-up studies are a logical next step to our observational investigation.