Primary care consultation patterns prior to suicide: a nationally representative case-control study.

Alothman, Danah; Lewis, Sarah; Fogarty, Andrew William; Card, Timothy; Tyrrell, Edward

Abstract

Consultation with primary health care may provide an opportunity to identify patients at higher suicide risk. To explore primary care consultation patterns in the 5 years before suicide to identify suicide high-risk groups and common reasons for consulting. A case-control study in England from 2001 to 2019 using electronic health records. Analysis of 14515 patients aged ≥15 who died by suicide and up to 40 matched live controls per case (N=594674). Frequent consultations (>once per month in the final year) were associated with increased suicide risk (age and sex adjusted odds ratio (OR) 5.88; 95% CI: 5.47-6.32). The associated rise in suicide risk was seen across all sociodemographic groups as well as in those with and without psychiatric comorbidities. However, specific groups were more influenced by the effect of high-frequency consultation (>once per month in the final year) demonstrating higher suicide risk compared to their counterparts who consulted once: females (adjusted OR 9.50; 95% CI: 7.82-11.54); patients aged 15 to 45 (adjusted OR 8.08; 95% CI: 7.29-8.96); patients experiencing less socioeconomic deprivation (adjusted OR 6.56; 95% CI: 5.77-7.46); and those with psychiatric conditions (adjusted OR 4.57;95% CI: 4.12 to 5.06). Medication review, depression and pain were the commonest reasons for which suicide decedents consulted in the year before death. Escalating, or more than monthly consultations are associated with increased suicide risk regardless of patients' sociodemographic characteristics and regardless of the presence (or absence) of known psychiatric illnesses.

Citation

Alothman, D., Lewis, S., Fogarty, A. W., Card, T., & Tyrrell, E. (2024). Primary care consultation patterns prior to suicide: a nationally representative case-control study. British Journal of General Practice, 74(744), e426-e433. https://doi.org/10.3399/bjgp.2023.0509

• Journal Article Type: Article
• Acceptance Date: Feb 1, 2024
• Online Publication Date: Feb 8, 2024
• Publication Date: 2024-07
• Deposit Date: Feb 13, 2024
• Publicly Available Date: Feb 13, 2024
• Journal: British Journal of General Practice
• Print ISSN: 0960-1643
• Electronic ISSN: 1478-5242
• Publisher: Royal College of General Practitioners
• Peer Reviewed: Peer Reviewed
• Volume: 74
• Issue: 744
• Pages: e426-e433
• DOI: https://doi.org/10.3399/bjgp.2023.0509
• Keywords: primary care, family practice, consultation, suicide, general practice
• Public URL: https://nottingham-repository.worktribe.com/output/31441225
• Publisher URL: https://bjgp.org/content/74/744/e426