Suicidality, Depression, and Mental Health Service Use in Canada

Article excerpt

Objective: To determine the magnitude of depression and suicidal populations, the overlap between these populations, and the associated patterns of mental health service use.

Method: We examined depression, suicidality (ideation and nonfatal behaviours), and the mental health service use of participants in the Canadian Community Health Survey Cycle 1.2: Mental Health and Well-Being. The sample comprised 36 984 household members aged 15 years or over.

Results: Approximately 4% to 5% of the population suffered from a major depression or suicidality. About 2 of 3 of those who were suicidal did not suffer from depression, and over 70% of those with depression did not report suicidality. Persons with depression and suicidality or depression (but no suicidality) were the 2 groups most likely to report ambulatory mental health contacts, and the provider groups contacted most often included physicians. The use of provider groups was considerably lower for those who were suicidal (but had no depression). Whereas the latter were more likely to report contacts than not, suicidality, in and of itself, did not exert a strong effect on contact with any particular provider group. For those who were suicidal (but who had no depression), less than 1 in 3 reported any mental health service contact, including an inpatient mental health stay.

Conclusions: The lack of contact by those who are suicidal (but who have no depression) is provocative, given that almost 2 of 3 of the suicidal subjects had no depression. Detrimental outcomes such as depression may develop without effective early interventions and uptake by a sufficient supply of appropriately trained and financially accessible personnel.

(Can J Psychiatry 2006;51:35-41)

Information on funding and support and author affiliations appears at the end of the article.

Clinical Implications

* Persons who are suicidal but do not meet the criteria for a major depression may not come to the physicians' attention until they experience a major depression.

* While this pattern of use may seem appropriate given available treatment options, less than one-third of the suicidal people without depression reported any mental health contact.

* Without access to effective treatment, this group may not seek treatment, may worsen, and (or) may take their lives.

Limitations

* Individuals with severe, acute depression and (or) suicidality might not have been included due to premature mortality or they resided in settings not included in the sample design.

* Recall of mental health service use even over a 12-month period may be biased.

* Cross-sectional surveys are limited in determining the proportion of people who have benefited from treatment in the past or who will do so in the future.

Key Words: Mental health services use, depression, attempted suicide, suicide ideation, Canada

Depression and suicidality (ideation and nonfatal behaviours) contribute strongly to premature mortality and are costly, disabling conditions internationally (1-7). Thus the widespread uptake of effective interventions for individuals who are suicidal or who have depression could have a major public health impact. A core symptom of depression is suicidal ideation. As such, suicidal ideation and behaviours may arise from depression or other conditions. There is a large body of evidence concerning the benefits of treating depression. However, there is an ongoing controversy about the relative merits of prescribing the newer antidepressants to those who have depression. While the newer antidepressants are less toxic if taken in overdose, suicidality may arise or become more intense for some (at least initially) (8-11). Even less is known about treatment effectiveness for those who are suicidal (12-14). Until recently, there has been a lack of systematic evidence and guidelines about how to treat those who are suicidal apart from, or in addition to, concurrent conditions such as depression (15,16). …