Are there gender differences in mental healthcare utilisation preceding deaths of despair? A retrospective cohort study of Norwegian register data (2008-2017).

OBJECTIVE

Marked gender differences have been observed in 'deaths of despair', with suicides, drug overdoses and alcohol-related diseases more common among men. The present study examines whether men use fewer mental healthcare services than women during the years before dying from diseases of despair.

DESIGN

Retrospective cohort study: population-wide administrative register data, covering all registered inhabitants of Norway, are analysed using descriptive statistics, logistic regression and ordinary least squares linear probability models. The regression models are adjusted for age and sociodemographic covariates (marriage, immigrant background, education and employment status), measured at baseline (2008).

SETTING

Norway 2008-2017.

PARTICIPANTS

Men (number of observations (n) = 1 593 044) and women (n=1 569 717) who fell within the 15-69 age range in 2008 and were still alive and residing in Norway in 2014.

OUTCOME MEASURES: Mental healthcare utilisation during a 6-year period (2009-2014) is monitored in men and women who died prematurely (<70 years) from diseases of despair (2015-2017). Utilisation of inpatient and outpatient hospital care for mental and behavioural disorders covers the International Classification of Diseases, 10th version (ICD-10) codes F00-F99. Deaths of despair comprise the following ICD-10 codes: suicides (X60-84, Y87.0); alcoholic liver diseases and cirrhosis (K70, K73-74) and drug overdoses (X40-45, Y10-15, Y45, Y47, Y49).

RESULTS

Deaths of despair occurred more often among men (n=1337, 0.084%) than women (n=522, 0.033%) in Norway 2015-2017. Recipients of social assistance (OR 7.05 (CI 5.95 to 8.34) for men; OR 5.97 (CI 4.33 to 8.25) for women) and disability benefits (OR 2.65 (CI 2.27 to 3.09) for men; OR 3.33 (CI 2.64 to 4.19) for women) had particularly high odds of dying from diseases of despair. Males had a lower probability than females of seeking treatment for mental and behavioural disorders preceding deaths of despair in all six observational years (2009-2014). Roughly half of men and approximately one-third of women did not have any contact with specialised mental healthcare services during the entire 6-year period before death.

CONCLUSIONS

Men use fewer mental healthcare services than women during the years before dying from diseases of despair.