Does Managed Care also increase Suicide Risk?

A colleague recently made some interesting observations after reading a recent study of suicidality (Hall, R.C. et al. Suicide risk assessment: A review of risk factors for suicide in 100 patients who made severe suicide attempts. Psychosomatics 40:1, 18-27.):

• Of the severe suicide attempters seen in a hospital emergency room in this study, 86 percent were insured by an HMO or managed care plan. In the area in which the study was conducted, only there is only 35 percent managed care penetration, thus leading to the conclusion that "managed care coverage was over-represented in these attempted suicide cases by 240 percent."


• "Suicide remains the ninth leading cause of death in the United States...In recent years,there has been concern that the suicide rate is actually increasing as care becomes less generally available and managed care bureaucracies make it more difficult to provide appropriate help to a person in a timely fashion." [Hall, 1997; Levenson, 1987; Grumet, 1989; Cuttler, 1991; Relman, 1992] (p.21)


• Of 100 severe suicide attempts: "Forty-one percent of the patients in our study had some type of chronic, deteriorating medical illness. Eight had been medically hospitalized within 6 months of the time that they attempted suicide. All of these patients felt frustrated with their ability to access medical care and to get appropriate medical treatment for their condition. Specifically, many were angry with their managed care provider and felt they were not being treated seriously or appropriately." (p.24)

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