Utilization of and Barriers to Treatment Among Suicide Decedents: Results From the Army Study to Assess Risk and Resilience Among Servicemembers (Army STARRS)

Objective: To examine suicide decedents' use of mental health treatment and perceived barriers to initiating and maintaining treatment. Method: We used a psychological autopsy study conducted as part of the Army Study to Assess Risk and Resilience Among Servicemembers (Army STARRS) that compared suicide decedents (n = 135) to soldiers in two control conditions: those propensity-score-matched on known sociodemographic and Army history variables (n = 137) and those with a history of suicidal thoughts in the past 12 months (n = 118). Informants were next of kin and Army supervisors. Results: Results revealed that suicide decedents were significantly more likely to be referred to services and to use more intensive treatments (e.g., medication, overnight stay in hospital) than propensity-matched controls. However, decedents also were more likely to perceive significant barriers to treatment-seeking. All differences observed in the current study were between propensity-matched controls and decedents, with no observed differences between suicide ideators and decedents. Conclusions: Many suicide decedents used some form of mental health care at some point in their lives; however, they also were more likely than propensity-matched controls to perceive barriers that may have prevented service use. The lack of differences between suicide ideators and decedents suggests that more information is needed, beyond knowledge of treatment utilization or perceived barriers, to identify and intervene on those at highest risk for suicide. These findings underscore the importance of reducing attitudinal barriers that may deter suicidal soldiers from seeking treatment, and also improving risk detection among those who are attending treatment. What is the public health significance of this article? Prior studies have suggested that many suicide decedents have no contact with mental health care providers in the months preceding their deaths; however, these studies have relied largely on care that is documented in medical records. We sought to better understand treatment utilization (including those not commonly documented such as the use of crisis hotlines and clergy) and perceived barriers to initiating and maintaining treatment among soldiers who died by suicide using a psychological autopsy study. Although suicide decedents were more likely to utilize intensive treatment options compared to propensity-matched controls, they were also more likely to perceive attitudinal barriers