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Multicenter Study
. 2009 Nov;59(568):825-32.
doi: 10.3399/bjgp09X472881.

Primary care contact prior to suicide in individuals with mental illness

Anna Pearson  1 , Pooja Saini, Damian Da Cruz, Caroline Miles, David While, Nicola Swinson, Alyson Williams, Jenny Shaw, Louis Appleby, Navneet Kapur
Affiliations
Multicenter Study

Primary care contact prior to suicide in individuals with mental illness

Anna Pearson et al. Br J Gen Pract. 2009 Nov.

Abstract

Background: Previous 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.

Aim: To 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 study: Retrospective case-note study and semi-structured interviews.

Setting: General practices in the northwest of England.

Method: General practice data were obtained by a retrospective review of medical records (n = 247) and semi-structured interviews with GPs (n = 159).

Results: GP 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 kappa = 0.024).

Conclusion: Consultation 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.

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Figures

Figure 1
Figure 1
Total number of GP consultations in the 12 months before death (n = 247).
Figure 2
Figure 2
Time between final GP consultation and death (n = 224).
See this image and copyright information in PMC

Comment in

  • The challenge of improving patient safety in primary care.
    Dodds A, Fulop N. Dodds A, et al. Br J Gen Pract. 2009 Nov;59(568):805-6. doi: 10.3399/bjgp09X472845. Br J Gen Pract. 2009. PMID: 19861023 Free PMC article. No abstract available.
  • Suicide in later life.
    Manthorpe J, Iliffe S. Manthorpe J, et al. Br J Gen Pract. 2010 Feb;60(571):129-30; author reply 130. doi: 10.3399/bjgp10X483193. Br J Gen Pract. 2010. PMID: 20132706 Free PMC article. No abstract available.

References

    1. Luoma JB, Martin CE, Pearson JL. Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry. 2002;159(6):909–916. - PMC - PubMed
    1. Pirkis J, Burgess P. Suicide and recency of health care contacts. A systematic review. Br J Psychiatry. 1998;173:462–474. - PubMed
    1. Vassilas CA, Morgan HG. General practitioners' contact with victims of suicide. BMJ. 1993;307(6899):300–301. - PMC - PubMed
    1. Vassilas CA, Morgan HG. Elderly suicides' contact with their general practitioner before death. Int J Geriatr Psychiatry. 1994;9:1008–1009.
    1. Harwood DMJ, Hawton K, Hope T, Jacoby R. Suicide in older people: mode of death, demographic factors and medical contact before death. Int J Geriatr Psychiatry. 2000;15(8):736–743. - PubMed

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