Predictors of not receiving mental health services among people at risk of suicide: A systematic review

• Published in: Journal of affective disorders Vol. 301; pp. 172 - 188
• Main Authors: Tang, Samantha, Reily, Natalie M., Arena, Andrew F., Sheanoda, Veronica, Han, Jin, Draper, Brian, Batterham, Philip J., Mackinnon, Andrew J., Christensen, Helen
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15-03-2022
• Subjects: Cross-Sectional Studies; Ethnicity; Humans; Mental Health Services; Service utilization; Suicidal Ideation; Suicide; Suicide - prevention & control; Systematic review; Service utilization; Systematic review; Mental health services; Suicide
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2022.01.054

•Predictors of mental health service non-use were assessed in people with suicidality.•35 studies assessing 66 risk factors were eligible.•Prevalence of non-use of formal mental health service ranged from 26 to 92%.•The most consistent predictors were minority ethnicity and low severity of suicidality.•Further research assessing reasons for service non-use is needed.
The majority of people who die by suicide are unknown to formal mental health services. The current review identified predictors of non-receipt of mental health services among individuals experiencing suicidal thoughts or behaviours. Such data provides insight into the needs and preferences of these individuals and inform improvements to existing services.
PsycInfo, PubMed/Medline, CINAHL, and Web of Science were systematically searched from 1st January 1980 up to 20th September 2021. Included studies examined predictors of not receiving formal mental health services among people at risk of suicide. Study quality was assessed by adapting the Joanna-Briggs Institute Checklist for Analytical Cross-Sectional Studies. Findings were presented with narrative synthesis. PROSPERO registration: CRD42021256795.
Included studies (n = 35, sample range = 46–19,243) were predominately conducted in the United States. Non-receipt of services in nationally representative studies was varied (25.7–91.8%). Results indicate that non-receipt of mental health services among people with suicidality is associated with minority ethnicity, better perceived general health, lower psychological distress, lower severity of suicidality, no mental health diagnosis, lower perceived need for treatment and lower use of medical services.
Limitations included few studies conducted in low-middle income countries, limited literature on key predictors of interest, and exclusion of informal sources of support.
Individuals with suicidality who are unknown to mental health services have diverse attributes. For some, non-use of services may result from low suicidal distress and perceived need for treatment. Further research is needed to understand why these predictors are associated with service non-use.