Table 1.

Characteristics of Included Studies (N = 24)

Study	Sample	Study Design/Method	Study Aim	Key Findings
Calear et al. (2014)	N = 1 274 community sample of Australian adults aged 18 years and older.	Quantitative. Data were collected using online survey.	To investigate the relationships between suicide literacy, stigma, and help-seeking attitudes and intentions.	More positive attitudes and greater intentions for help-seeking were found related to low suicide stigma, high suicide literacy, lower level of depressive symptoms, female gender, and greater age.
Kageyama (2012)	N = 4 487 community sample of Japan residents aged 40–74.	Quantitative. Data were gathered using a self-administered questionnaire.	To examine the relationship between views on suicide, demographic factors, and feeling of shame in help-seeking.	Being older (ie, aged 70–74), living in a high suicide standardized mortality ratio or rural areas, holding a pessimistic life view, and viewing suicide as a matter of self-choice, were related to an increased likelihood of feeling shame for suicide help-seeking.
Na et al. (2018)	N = 1 200 community sample of Koreans aged 13 and older.	Quantitative. Data were collected through in-person surveys.	To examine the role of age on attitudes toward suicide.	Increased age was found associated with a less favorable attitude toward suicide, which may impede suicide help-seeking.
Blais et al. (2015)	N = 2 025 community sample of veterans aged 60 and older (Mage = 71.0 for full sample, Mage = 67.6 for distressed subsample).	Quantitative. Data were drawn from the 2011 National Health and Resilience in Veterans Study.	To examine correlates (ie, facilitators and barriers) of current mental health care utilization.	Current suicidal ideation was positively associated, whereas negative beliefs about mental health care and age were negatively associated, with the utilization of services among distressed veterans.
Hom et al. (2016)	N = 483 current and retired firefighters aged 18–65 with a career history of suicide ideation, plans, or attempts (Mage = 36.39).	Quantitative. Data were collected through a national web-based survey.	To identify the prevalence, types, and correlates of mental health service use, as well as barriers to help-seeking, among firefighters with a career history of suicide ideation, plans, or attempts.	Participants reported an overall service use rate of 77%. Firefighters with a history of suicide attempts were more likely to use services than those with ideation only and those with plans but no attempts. Middle-aged participants (ie, 35–44 years and 45–54 years) were at higher odds of service use. In addition, volunteer firefighters, those with shorter service history, serving in small towns or rural areas, with lower incomes, were less likely to utilize mental health services.
Hom et al. (2018)	N = 199 women firefighters aged 19–58 in the United States reporting a career history of suicide ideation, plans, and/or attempts (Mage = 35.87).	Quantitative. Data were collected through a web-based survey.	To determine rates of professional and nonprofessional service use during firefighting careers, and to identify preferred sources, correlates, and barriers to mental health service use.	About 73% of participants reported the use of professional mental health services, and 44% reported the use of other sources of support during careers. Those who were of greater age, with longer service history, and serving as career firefighters (vs volunteer), were more likely to use professional services.
Shaw and Chiang (2019)	N = 63 696 at-risk callers to Taiwan National Suicide Prevention Hotline (NSPH).	Quantitative. Secondary analysis of NSPH caller records between 2009 and 2011.	To examine the demographic characteristics of the NSPH callers and to assess the effectiveness of NSPH service in alleviating callers’ emotional distress and suicide risk.	Male and the older (eg, aged 60+), as well as those living outside northern Taiwan, were found less likely to use the NSPH services. Findings indicated that NSPH services were effective in reducing callers’ emotional distress and suicidality.
Han et al. (2016)	N = 2 616 Korean adults aged 19 and older with past-year suicidal ideation (Mage = 48.75).	Quantitative. Secondary analysis using nationally representative cross-sectional data from Korean National Health and Nutrition Examination Survey 2010–2012.	To examine the relationship between socioeconomic factors and mental health service use among people with suicidal ideation.	Service nonuse was found associated with being older (50–64 years, and 65+), widowed, with high school level education, working as a paid employee, absence of depressive mood, with no suicide attempt, and no reported problems in usual activities.
Dey and Jorm (2016)	N = 16 640 community sample of Swiss youth and adults aged 15 and older.	Quantitative. Secondary analysis using data from the 2012 Swiss Health Survey.	To examine the presence of help-negation using a Swiss sample.	Few participants with the highest level of suicidality engaged in treatment. Compared to nonsuicidal people, those who experienced suicidality for several days were found to be more likely to engage in treatment. The role of age on treatment engagement was identified but varied by gender.
Ko et al. (2019)	N = 1 414 community sample of working-age adults aged 26–64 with reported past year suicidal ideation.	Quantitative. Secondary analysis of 2011 and 2012 National Survey on Drug Use and Health data.	To identify the factors associated with help-seeking among working-age adults reporting suicide ideation.	Factors related to not seeking help included: male gender, being non-White, working full-time, without health insurance, and with lower mental health needs.
Corna et al. (2010)	N = 12 792 community sample of adults in Canada aged 55 years and older (Mage = 67).	Quantitative. Secondary analysis of The Canadian Community Health Survey 1.2: Mental Health and Well-being, nationally representative, cross-sectional data	To estimate the lifetime and 12-month prevalence of suicide ideation among community-dwelling older adults, and examine the association between suicidal thoughts and mental health problems (ie, major psychiatric disorder) and service use.	Less than half of participants with reported past-year suicide ideation accessed any mental health care. Being older, male, had higher social support were associated with a decreased likelihood of mental health service use. Whereas the presence of psychiatric disorders and suicidal thoughts were associated with increased odds of service use.
Vasiliadis et al. (2013)	N = 2 004 community sample of French-speaking older adult (aged 65 and older) population living in Quebec.	Quantitative. Secondary analysis using data from Enquête sur la Santé des Aînés, a cross-sectional survey conducted in 2005–2008	To investigate gender-specific determinants of antidepressant and mental health service use for suicidal ideation.	Prevalence rates of mental health service use and antidepressant use were lower among male participants with suicidal ideation, relative to female counterparts. Among these suicidal ideation-reporting participants, the presence of depression was found related to both mental health service use and antidepressant use. Additionally, younger age was found associated with a greater likelihood of antidepressant use.
Mackenzie et al. (2010)	N = 3 017 community sample of adults aged 55 and older.	Quantitative. Secondary analysis using nationally representative data from Collaborative Psychiatric Epidemiologic Surveys	To investigate correlates of older adults’ perceived need for mental health services (ie, sought professional mental health services, and with perceived need but didnot seek/receive help).	The lowest level of perceived need was found among participants aged 65 and older and highest among those aged 25–44. Among those with perceived needs for help, greater age (aged 75+ vs 55–64 years) was found to be positively related to help-seeking.
Sheehan et al. (2018)	N = 17 338 community sample of adults who reported suicidal ideation and/or behavior during past 12 months. Average age was 26–34 years.	Quantitative. Secondary analysis using nationally representative data from National Survey on Drug Use and Health, 2009–2016.	To investigate racial/ethnic differences in mental health service use among suicidal adults at varied levels of suicidal severity and clinical care intensity.	Past year mental health service use rates were approximately 47% among individuals with severe suicidal ideation (but no attempts) and 55% among suicide attempters, respectively. Racial/ethnic differences were more pronounced in outpatient care, in relative to inpatient care, and varied by suicidal history (ie, suicidal ideators with no attempt vs suicide attempters).
Kisely et al. (2011)	N = 108 death records from Nova Scotia Medical Examiner Service (NSMES; Mage = 44.73).	Quantitative. Data were extracted from the NSMES for suicide cases in 2006 and linked to the provincial administrative databases.	To assess and compare sociodemographic characteristics of people who sought professional help or disclosed intent before suicide, with people who did not.	Seventy-six participants made contact with health professionals, and 46 disclosed suicidal intent, in the year prior to suicide. Adults aged 40–49 had the highest number of suicide cases in the sample, but were least likely to disclose suicidal intent.
Byers et al. (2016)	N = 1 139 community sample of adults aged 18 and older with prior suicidal behavior and current mood or anxiety disorders (Mage = 38.6).	Quantitative. Data were drawn from the nationally representative Collaborative Psychiatric Epidemiology Surveys (2001–2003).	To estimate the prevalence of current (ie, during past 12 months) mental health service utilization by adults with prior suicidal behavior and current mood or anxiety disorders and to examine differences in use by racial-ethnic, age, and gender.	In general, the service use rate was low (<50%). Service use rates were highest among middle-aged adults, compared with the younger and older. African Americans had the lowest use in relative to other racial/ethnic groups. Yet, service use by African Americans increased across the life course, while other groups showed a decrease in service use with older age.
Stanley et al. (2015)	N = 2 126 for past-year suicidal ideation, N = 690 for suicide plans, and N = 345 for suicide attempts, from a community sample of adults aged 18 and older.	Quantitative. Data were derived from the 2013 National Survey on Drug Use and Health.	To identify factors associated with mental health service use among adults with past-year suicidality (ie, ideation, plans, or attempts).	About half of suicidal adults reported past year use of any type of mental health services. Being female, non-Hispanic Whites, with poorer general medical health, and greater severity in mental health clinical profile, were associated with increased likelihood of past-year service use.
Forma et al. (2017)	N = 1 118 suicide decedents (Mage = 77.5), and N = 304 955 natural death decedents (Mage = 83.1), who died in Finland at the age of 70 or older during 1998–2008. N = 222 967 individuals who lived longer (Mage = 81.9).	Quantitative. Secondary data analysis of nationwide register data in Finland.	To analyze the use of health and social services and purchase of medicine during the last 2 years of life among suicide decedents, and compare service use and medicine purchase with that of those who died of natural causes and those who lived longer.	Most (80% or above) older suicide decedents used health (hospital care) or social care (residential homes, sheltered housing, and home care) during last 2 years of their lives. Suicide decedents used less hospital and long-term care, but more psychotropic medication purchase, compared to natural death decedents, adjusting for morbidity. Home and long-term care were used more commonly among older suicide decedents (aged 80+) than the younger (aged 70–79).
Leavey et al. (2016)	N = 399 cases of suicide recorded by the Northern Ireland Coroner Service in 2007–2009 (Mage = 39.16).	Quantitative. A retrospective cohort analysis of deaths recorded as suicide.	To investigate predictors of suicide decedents’ service contact (ie, with health and social care services) in the 12 months prior to suicide and of general practitioners’ vigilance to suicidality.	Over 80% of suicide decedents contacted General Practice services in the 12 months prior to suicide, and the majority of these consultations were attended for mental health problems. Age (35–54 years) was identified as one significant predictor of general practice service contact for mental health problems at 1, 3, and 12 months prior to suicide.
Fontanella et al. (2017)	N = 1 338 decedents aged 19 to 65 died by suicide in 2008–2013.	Quantitative. Data were extracted from death certificate files and linked to Ohio Medicaid claims files.	To describe clinical profiles and service use of suicide decedents enrolled in Ohio Medicaid.	Eighty-three percent of decedents made one or more general medical and/or mental health visits during their last year prior to suicide. Decedents with mental disorder diagnoses, substance use disorder, and/or chronic health conditions, as well as those who were older (30–49 and 50–65) and female, were more likely to use service in the last month of life. However, older decedents were less likely to make mental health-only visits during the last month.
Liu et al. (2012)	N = 4 406 suicide decedents over age 15 in Taiwan that died in 2006.	Quantitative. Data were obtained from Death Certificate Data file and linked to National Health Insurance beneficiary registry file.	To analyze the characteristics of suicide decedents in their use of outpatient visits and health care during the last year of life.	Rates of a visit by suicide decedents during the last year of life were 85% for overall outpatient services and 30.2% for mental disorders service only. Females were more likely to have outpatient care visits for mental disorder purposes. Individuals 65 years and older had the highest overall rate of visits (97.1%), but the lowest rate for mental disorder visits (25.8%), compared to other age groups.
Waitz-Kudla et al. (2019)	N = 267 suicide decedents. Aged 13–80 (Mage = 36.19).	Quantitative. Data were collected from loss survivors through Qualtrics surveys.	To examine the association between lifetime mental health help-seeking and religious and political beliefs among suicide decedents.	Seventy-five percent of decedents have sought help (ie, taking medication and/or seeing a provider for any mental illness). Suicide decedents with conservative political views (vs those with liberal views) were at a decreased likelihood to seek mental health help before death.
Mallon et al. (2019)	N = 403 suicide decedents in Northern Ireland died between 2007 and 2009. This study focused on the male cohort (n = 325).	Mixed methods. Data were drawn from Coroner’s records and linked to general practice records.	To examine cases of suicide with no recent (ie, last year of life) health care contact, and to identify factors related to not seeking help.	Eighteen percent of male decedents did not seek support from general practitioners during the last year of life. Older decedents (aged 45–64 and 65+) were more likely to have sought help, compared to the younger.
Troya et al. (2019)	N = 16 community sample of participants, including 9 older adults aged 60 who self-harm and 7 third-sector support workers in England.	Qualitative. Data were collected through semistructured interviews.	To examine factors (ie, facilitators and barriers) associated with accessing primary care.	Study identified 3 domains of barriers, including internal (eg, stigma), practical (eg, mobility restrictions), and external (eg, attitudes of healthcare professionals). Key facilitators included older adults’ internal factors (eg, health status and previous positive care experiences), external (eg, providers’ empathy), and structural (availability of regular and continuous support).