Angerhofer Julie E, Cruz Maricela, Shaw Jennifer, Stewart Christine, Runkle Artie, Wolter Erika, Holden Erika, Medlock Shannon, Quintana LeeAnn, Kuo Elena Noon, Trejo Juanita, King Roxanna, Boggs Jennifer
MMWR Morb Mortal Wkly Rep. 2025 Jun 12;74(21):365-371. doi: 10.15585/mmwr.mm7421a2.
Firearms are the most common means of suicide in the United States and a leading cause of death among all persons aged 10-64 years. Most persons who die by suicide see a clinician in the year preceding their death; thus, health care encounters are important opportunities for suicide prevention. Persons who die by firearm suicide differ demographically and clinically from those who die by other suicide means, suggesting that opportunities for prevention might also differ between these groups. This report examined patterns of health care use in the year preceding suicide death to identify potential opportunities for prevention among persons who died by firearm suicide and those who died by other means of suicide. State cause-of-death records for 2020-2022 were linked to electronic health records from health systems in Alaska (Southcentral Foundation) and Colorado and Washington (both Kaiser Permanente). Quarterly past-year health care use preceding death was examined across service settings, including primary care, outpatient mental health specialty care, emergency care, and inpatient care. During 2020-2022, across the three health systems, 683 persons died by suicide. The majority of these deaths (54.6%) occurred by firearm. Patterns of past-year health care use preceding suicide were similar for persons who died by firearm and other suicide means, with the exception of mental health care, which was significantly lower in specialty and primary care settings. These findings suggest that many persons who die by firearm suicide do not access mental health care before their death. Suicide prevention practices in health care, designed to help identify and engage persons at risk in supportive care, need to reach beyond mental health encounters, particularly for firearm suicide prevention.
在美国，枪支是最常见的自杀方式，也是10至64岁人群死亡的主要原因。大多数自杀死亡者在死前一年会去看临床医生；因此，医疗保健接触是预防自杀的重要机会。死于枪支自杀的人与死于其他自杀方式的人在人口统计学和临床特征上有所不同，这表明这两组人群的预防机会可能也有所不同。本报告研究了自杀死亡前一年的医疗保健使用模式，以确定死于枪支自杀者和死于其他自杀方式者的潜在预防机会。2020年至2022年的州死亡原因记录与阿拉斯加（中南部基金会）、科罗拉多州和华盛顿州（均为凯撒医疗机构）卫生系统的电子健康记录相链接。对死亡前过去一年按季度的医疗保健使用情况在包括初级保健、门诊心理健康专科护理、急诊护理和住院护理在内的服务环境中进行了检查。在2020年至2022年期间，在这三个卫生系统中，有683人自杀死亡。其中大多数死亡（54.6%）是由枪支造成的。死于枪支自杀和其他自杀方式的人在自杀前过去一年的医疗保健使用模式相似，但心理健康护理除外，心理健康护理在专科和初级保健环境中的使用显著较低。这些发现表明，许多死于枪支自杀的人在死前没有获得心理健康护理。旨在帮助识别有风险的人并让其接受支持性护理的医疗保健中的自杀预防措施，需要超越心理健康接触，特别是对于枪支自杀预防。
