Introduction
Major depressive disorder (MDD) is associated with suicide events and with increased healthcare resource utilization (HRU). The aim was to analyze the pattern of HRU prior to death by suicide or suicide attempt in patients with MDD using national registries.

Methods
Danish adults with MDD, who died by suicide or had a first-time suicide attempt, were matched with MDD controls on age, sex, and MDD severity and analyzed for psychiatric and non-psychiatric hospital and private practitioner contacts, and prescriptions 1 year prior to the event. For individuals having a second suicide attempt, HRU prior to first and second suicide attempt was analyzed.

Results
Among 1061 individuals dying by suicide and 3759 individuals with suicide attempt, compared with their controls, the proportion with psychiatric hospitalization was more than 50% increased, mainly accounted for by acute contacts. The difference to the matched controls decreased with increasing MDD severity. Non-psychiatric HRU was increased as well. The proportion with psychiatric hospitalizations or ED visits was reduced prior to the second attempt compared with first attempt.

Conclusion
Among individuals with MDD, psychiatric and non-psychiatric HRU was increased 1 year prior to suicide event. The proportion of individuals who had psychiatric HRU decreased from first to second suicide attempt.