Abstract: Background: Suicide is a major global public health issue, and understanding patterns of healthcare utilization prior to suicide may inform prevention strategies. Gender differences in help-seeking behaviors, particularly in relation to emergency and mental health services, are crucial yet underexplored components of suicide prevention efforts. While previous studies have suggested that women are more likely to seek professional help before suicide attempts, less is known about these patterns in cases of completed suicide.
Aim: The objective of this study was to analyze gender differences in the use of hospital emergency services and mental health care during the year preceding completed suicide among individuals in the autonomous community of Cantabria, Spain, between January 2020 and March 2022.
Methods: This retrospective observational study included 110 cases of completed suicide reported in Cantabria during the specified period. Clinical and administrative records were reviewed to determine the number of contacts each individual had with hospital emergency departments and mental health services in the 12 months prior to death. Descriptive statistics (mean and standard deviation) were used to summarize the data. Between-group comparisons (men vs. women) were conducted using the Wilcoxon rank-sum test (W), given the non-normal distribution of the data. Statistical significance was set at p < 0.05.
Results: A statistically significant difference was observed between men and women in their use of hospital emergency services in the year prior to suicide. Women had a higher mean number of visits compared to men (women: M = 3.0, SD = 3.0; men: M = 1.8, SD = 5.2; W = 529.0; p = 0.005). Similarly, women also had significantly more contacts with mental health services in the year before death (women: M = 2.4, SD = 3.9; men: M = 0.8, SD = 2.2; W = 517.5; p < 0.001). In terms of overall service utilization, 59.2% of the total sample (61 out of 103 individuals with complete data) had at least one recorded visit to a hospital emergency department in the 12 months prior to death by suicide. This high rate of contact with emergency services highlights a potentially critical window for intervention. Notably, mental health service use was generally low, particularly among men, suggesting barriers to accessing specialized care.
Conclusions: Our findings demonstrate meaningful gender differences in healthcare service use prior to completed suicide. Women who died by suicide were significantly more likely than men to have sought help from both hospital emergency services and mental health providers during the final year of life. Moreover, a majority of individuals in this cohort had some form of contact with emergency services before death, suggesting missed opportunities for suicide prevention. These findings underscore the importance of gender-sensitive approaches and the integration of suicide risk screening protocols within emergency and mental health care settings to identify individuals at heightened risk. Improving coordination between emergency departments and mental health services, along with proactive follow-up strategies, could enhance early detection and intervention for individuals experiencing suicidal crises.
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