Mental healthcare contact and diagnoses prior to suicide among older adults in Norway: A register-based nested case-control study.

BACKGROUND

Suicide is a global public health concern, with the highest rates among older males in most countries. Access to mental healthcare is central to suicide prevention. This study examined mental healthcare contact among older adults who died by suicide compared with controls from the general population.

METHODS

Using Norwegian national health and administrative registries, we conducted a nested case-control study of individuals aged 60 and older who died by suicide between 2009 and 2021. Cases were matched on age and sex to controls from the general population. Mental healthcare contact and sociodemographic characteristics were described for cases and controls, and mental health diagnosis of cases in contact with mental healthcare services.

RESULTS

A substantial proportion of older adults who died by suicide (N = 2002) had prior mental healthcare contact. Specialized mental healthcare contact decreased with age and was more common among females than males (60-69: 50% vs. 38%; 70-79: 42% vs. 22%; 80+: 33% vs. 13%). Primary mental healthcare contact showed small sex differences and remained relatively stable (24-30%) across age. Depression or depressive symptoms were common among cases in both specialized (35%) and primary care (36%). Among those without mental health contact, cases more often were males, never married, and living alone than controls.

CONCLUSION

Older adults who died by suicide received care across multiple healthcare levels and were often diagnosed with depressive symptoms, highlighting the need for prevention and treatment across mental healthcare settings. Improving prevention strategies, particularly among older males, may strengthen suicide prevention in later life.