Primary care contact prior to suicide in individuals with mental illness

Abstract

BackgroundPrevious studies have reported differing rates of consultation with GPs prior to suicide. Patients with a psychiatric history have higher rates of consultation and consult closer to the time of their death. AimTo investigate the frequency and nature of general practice consultations in the year before suicide for patients in current, or recent, contact with secondary mental health services. Design of studyRetrospective case-note study and semi-structured interviews. SettingGeneral practices in the northwest of England. MethodGeneral practice data were obtained by a retrospective review of medical records (n = 247) and semistructured interviews with GPs (n = 159). ResultsGP records were reviewed in 247 of the 286 cases (86%). Overall, 91% of individuals (n = 224) consulted their GP on at least one occasion in the year before death. The median number of consultations was 7 (interquartile range = 3-10). Interviews were carried out with GPs with regard to 159 patients. GPs reported concerns about their patient's safety in 43 (27%) cases, but only 16% of them thought that the suicide could have been prevented. Agreement between GPs and mental health teams regarding risk of suicide was poor. Both sets of clinicians rated moderate to high levels of risk in only 3% of cases for whom information was available (n = 139) (overall κ = 0.024). ConclusionConsultation prior to suicide is common but suicide prevention in primary care is challenging. Possible strategies might include examining the potential benefits of risk assessment and collaborative working between primary and secondary care.

Assessment and Management of Suicide Risk in Primary Care

“…1 The majority of individuals are in contact with their general practitioner (GP) prior to suicide, 2 particularly those with a mental illness who consult more frequently than other patients. 3 People with a mental illness are at increased risk of suicide.…”

Increasing Indigenous self‐harm and suicide in the Kimberley: an audit of the 2005–2014 data

“…A large number of those who die by suicide have had contact with primary health care providers within the month prior to the suicide (126). Educating primary health care workers to recognize depression and other mental and substance use disorders and performing detailed evaluations of suicide risk are important for preventing suicide.…”

Author's response

“…'), 1 'I do (my basic-life support update) every year, because there are four QOF points attached to having all clinical staff trained in basic life support within the last 18 months.' He then puts forward a rather reluctant argument demonstrating the cost-effectiveness of training in cardiopulmonary resuscitation (CPR); reluctant, because he has never encountered a cardiac arrest in the GP surgery in a quarter of a century, nor has anybody else ever told him of such an encounter.…”