People who die by suicide without having attended hospital-based psychiatric care: Who are the ones that do not seek help?

ackground
Little is known regarding those who die by suicide without having received help. The aim of this study was to compare those who died by suicide without having attended psychiatric care with controls (a) with a psychiatric diagnosis and (b) from the general population.
Methods
Cases were all individuals 15+ who lived in Denmark during 2010–2021 and had died by suicide without having attended hospital-based psychiatric care. Cases were matched to controls from the two comparison-groups using a 1:10 ratio and compared using age-and sex-adjusted logistic regression analyses. Geographical variations in psychiatric care utilization were examined.
Results
Among 7119 individuals who died by suicide, 3474 (48.8 %) had not attended psychiatric care. Compared to controls with a psychiatric diagnosis, cases were more likely to be male (OR, 3.9, 95% CI, 3.6–4.2), older (80+ years: OR, 10.7, 95 % CI, 9.2–12.5), have lost a close relative (OR, 1.8, 95 % CI, 1.3–2.6) or recently retired (OR, 1.4, 95 % CI, 1.0–1.1.8). Compared to controls from the general population, cases were associated with male sex (OR, 4.6, 95 % CI, 4.2–5.0), living alone (OR, 2.3, 95 % CI, 2.2–2.5), unemployment (OR, 2.1, 95 % CI, 1.8–2.5), as well as having lost a close relative (OR, 5.0, 95 % CI, 3.5–7.2) or divorced within the last 1 year (OR, 3.6, 95 % CI, 2.7–4.9).
Limitations
Characteristics and preceding events were limited to available register data.
Conclusions
About half of all who died by suicide had not attended psychiatric care. Being older, male, or exposed to recent stressors were some of the major markers when compared to controls.