Health Care Service Utilization Before Suicide Among Young Black Individuals: A National Case-Control Study

OBJECTIVE: Suicide is a leading cause of death among Black youths, with rates more than doubling over the past decade-the fastest increase of any racial-ethnic group. This study aimed to compare general medical and mental health service utilization of suicide decedents and matched nondecedents among Black youths with a lifetime behavioral diagnosis. METHODS: This population-based case-control study used 2010-2019 national Medicaid data linked to mortality records. Service use was analyzed at 1, 6, and 12 months before death for 875 young Black suicide decedents (ages 9-24 years) and 8,750 nondecedents matched on age at index date, sex, and state of residence, all of whom had a lifetime behavioral diagnosis. RESULTS: In the month before death, 38.6% of decedents had a health care visit (mental health, 23.2%; general medical health, 23.1%), 75.7% had a visit within 6 months, and 88.1% within 12 months. Compared with nondecedents at all time points, decedents had higher rates of mental health service use across all settings and more general medical inpatient and emergency visits. Inpatient and emergency mental health visits within 1 year of death were most strongly associated with suicide risk. Decedents were more likely to have had multiple mental health visits. The most common final contact among decedents was outpatient mental health. CONCLUSIONS: Black youths who died by suicide were more likely than nondecedents to engage in mental health and acute general medical care. The findings underscore the critical role of health care settings in identifying risk and preventing suicide among Black youths.