Utilization of mental health care among people bereaved by suicide in Norway: A trajectory analysis

Background

Losing a loved one to suicide is an extremely stressful event that is associated with mental health issues. However, little is known about the health care utilization of those bereaved by suicide. Identifying distinct trajectories of mental health care utilization can help reveal gaps in service provision, barriers to access, and opportunities for targeted interventions.

Aims

To uncover distinct patterns of mental health care utilization in association with suicide bereavement and explore sociodemographic factors and subsequent suicide risk associated with these patterns.

Method

We analyzed Norwegian population-wide registry data on mental health care utilization at three different levels among 14 781 adults bereaved by suicide from 2010 to 2019 using group-based multi-trajectory modeling to identify groups with distinct mental health care utilization trajectories. Socio-demographic differences between trajectory groups were analyzed in multinomial logistic regression models and the associated risk of suicide was obtained with cox proportional hazards regression models.

Results

We identified four distinct trajectories of mental health care utilization. Two distinct groups of individuals bereaved by suicide either rarely contacted mental health care providers (“Low”) or only consulted with general practitioners only ("GP only"). In the latter group, the utilization rate increased post-bereavement. One group of bereaved ("Acute increase") increased their mental health care utilization significantly after the loss, while another group ("High") consistently had a high utilization rate. These groups differed with respect to kinship to the deceased and sociodemographic factors. Individuals in the “GP only” and “High” group had significantly higher risk of suicide when compared to those in the “Low” group.

Conclusions

Individuals bereaved by suicide exhibited diverse patterns of mental health care utilization, reflecting a broad spectrum of needs and responses to loss.