The association between suicidal ideation with future suicide attempts and service utilization: a population cohort study in Ontario, Canada

BackgroundFew studies examine suicidal ideation and its relationship with suicide attempts and health service use using a community sample. ObjectiveTo examine the association between suicidal ideation with (i) future mental health service use, and (ii) future suicide attempts, in a general population sample. MethodsUsing the 2002 and 2012 Canadian Community Health Surveys - Mental Health cycles linked with health administrative data, this study followed 14,708 Ontarians 15 years and older in a retrospective cohort study to examine patterns of mental health service use within 1 year, and suicide attempts within 5 years of self-reported suicidal ideation. ResultsA total of 2.1% (n=302) of all survey respondents reported suicidal ideation alone in the past year and another 0.5% (n=76) reported having ideation-with-action (i.e. ideation with planning or previous suicide attempt). Ideation-with-action was associated with a higher likelihood of future suicide attempts and future mental health service use, when compared to suicidal ideation alone. However, the majority of survey respondents who attempted suicide within the five-year follow-up period did not report a previous attempt or ideation at baseline. ConclusionWhile suicidal ideation is statistically significantly associated with greater likelihood of suicide attempt within five years, most attempters did not self-report ideation at baseline. Further study is needed to measure suicidal outcomes longitudinally to allow for dynamic expression of suicidal ideation as outcomes such as suicide attempts are measured. Those with ideation-with-action are more intense users of mental health services than those with ideation alone, indicating that care is reaching the more severe ideators.