Suicide in the community and mental healthcare usage: A nationwide register-based study in the Netherlands

Background – suicide bereavement can have profound effects on mental health. It is unclear, however, how suicide in ones community is related to mental health, and whether specific communities, such as socially fragmented or economically deprived one, are affected differently.Methods – the current register-based study used an longitudinal cohort design (n=702,589) utilizing Dutch national registry data. Communities were identified using address registers to obtain postcode data. Community suicide exposure obtained from death registers was based on number of suicides in postcode during the follow up period. Mental healthcare usage was obtained from basic and specialized mental healthcare registers. We adjusted all association for socioeconomic neighborhood charactersitics. As moderators, we investigated community social fragmentation, proportion of non-Dutch residents, residential density and proportion of low income households.Results – more community suicide was associated with lower mental healthcare usage (log hazard ratio = -0.37 [95%CI = -0.37, -0.37]). A dose-response like relationship was observed for communities with higher categories of suicide rates and less mental healthcare usage. Socially fragmented communities and those with more migrant residents were least likely to use mental healthcare after high community suicide rates.Conclusions – communities which experience high suicide rates, especially socially fragmentted and migrant ones, could potentially benefit from more mental healthcare usage to prevent further suicides.