Firearms are the most common means of suicide in the United States and a leading cause of death among all persons aged 10-64 years. Most persons who die by suicide see a clinician in the year preceding their death; thus, health care encounters are important opportunities for suicide prevention. Persons who die by firearm suicide differ demographically and clinically from those who die by other suicide means, suggesting that opportunities for prevention might also differ between these groups. This report examined patterns of health care use in the year preceding suicide death to identify potential opportunities for prevention among persons who died by firearm suicide and those who died by other means of suicide. State cause-of-death records for 2020-2022 were linked to electronic health records from health systems in Alaska (Southcentral Foundation) and Colorado and Washington (both Kaiser Permanente). Quarterly past-year health care use preceding death was examined across service settings, including primary care, outpatient mental health specialty care, emergency care, and inpatient care. During 2020-2022, across the three health systems, 683 persons died by suicide. The majority of these deaths (54.6%) occurred by firearm. Patterns of past-year health care use preceding suicide were similar for persons who died by firearm and other suicide means, with the exception of mental health care, which was significantly lower in specialty and primary care settings. These findings suggest that many persons who die by firearm suicide do not access mental health care before their death. Suicide prevention practices in health care, designed to help identify and engage persons at risk in supportive care, need to reach beyond mental health encounters, particularly for firearm suicide prevention.

在美国，枪支是自杀最常见的手段，也是10至64岁所有年龄段人群死亡的主要原因之一。大多数通过自杀离世的人在去世前一年内都会看医生；因此，医疗健康接触点为预防自杀提供了重要的机会。用不同方式自杀的人在人口统计学和临床特征上有所不同，这表明这些群体的预防机会也可能存在差异。本报告分析了在自杀身亡前一年中医疗服务使用的模式，以识别枪支自杀者和其他自杀手段死者之间的潜在预防机会。2020年至2022年各州死亡原因记录与阿拉斯加（Southcentral Foundation）和科罗拉多及华盛顿（均为Kaiser Permanente）的电子健康记录进行了关联。研究了在自杀前一年内各个服务设置下的季度医疗使用情况，包括初级保健、门诊精神卫生专科护理、急诊和住院治疗。

2020年至2022年期间，在三个医疗机构中，共有683人因自杀死亡。其中大多数（54.6%）是通过枪支自杀的。对于用枪支和其他方式自杀的人群而言，在过去一年中的医疗服务使用模式相似，唯一例外的是精神健康护理在专业和初级保健机构中的利用率显著较低。这些发现表明，许多通过枪支自杀的人在去世前并没有接受过精神健康服务。因此，医疗系统中设计用于识别并帮助有自杀风险人员获得支持性治疗的预防措施需要超出仅针对心理健康接触点的范围，尤其是在防止枪支自杀方面更为重要。