In this review, we did not set limits on the timeframe examined rather, this information was extracted from included studies. Longer timeframe studies that classify decedents as “in services” based on lifetime use may inaccurately reflect service use in response to direct precipitants of suicide. Shorter timeframe studies that classify decedents as “not in services” based on data from the weeks before death may miss service use in the months before death. One complexity in the literature is that studies consider a range of timeframes of mental health service use, ranging from non-use at time of death to non-use across an individual's lifetime. Additionally, formal services are more likely to deliver evidence-based treatments compared to informal supports. We focused on non-receipt of formal mental health services, rather than informal support as the primary outcome, given the focus of available literature, and since formal service use data is more easily verifiable by administrative health records linkage. Identifying the characteristics associated with non-use of services within this population is critical to address these barriers, develop alternative pathways into services, re-design current services, and inform the development of novel interventions or more appropriate “care” models. We recognize that people may not use formal services for variety of reasons, including service inaccessibility or unaffordability, stigma, poor mental health literacy, preference for informal support, or negative past healthcare experiences. ( 9) examined barriers and facilitators of help-seeking for suicidality, but this review did not examine other factors associated with help-seeking, such as demographic and diagnostic characteristics. Furthermore, a systematic review by Hom et al. However, this review did not have a primary focus on people who died by suicide. ( 8), which examined predictors of help-seeking across different levels of suicidality, found that help-seeking for suicidality was associated with female gender, older age, non-minority ethnicity, presence of mental health issues, and greater severity of suicidality. To our knowledge, only two other systematic reviews have examined predictors of service use in a suicidal population. The current systematic review provides a comprehensive overview of predictors of non-receipt of formal mental health services among people who died by suicide, consolidating work in existing reviews on predictors of service utilization among those with common mental health issues ( 6, 7). Although it is not possible to obtain first-hand reports from people who have died by suicide, coronial data can provide insights into the characteristics of this population and guide opportunities for suicide prevention efforts by policymakers, researchers, and service providers. Research has focused on understanding suicide risk factors, but not on identifying factors specifically for those who did not receive mental health services prior to suicide. Notably, over two-thirds of individuals who die from suicide do not receive professional mental health support ( 2). Suicide is the leading cause of death for Australians aged 15–49 ( 1).
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