Primary care consultation patterns before suicide: a nationally representative case-control study

Abstract

Background: Consultation with primary healthcare professionals may provide an opportunity to identify patients at higher suicide risk.

Aim: To explore primary care consultation patterns in the 5 years before suicide to identify suicide high-risk groups and common reasons for consulting.

Design and setting: This was a case-control study using electronic health records from England, 2001 to 2019.

Method: An analysis was undertaken of 14 515 patients aged ≥15 years who died by suicide and up to 40 matched live controls per person who died by suicide (n = 580 159), (N = 594 674).

Results: Frequent consultations (>1 per month in the final year) were associated with increased suicide risk (age- and sex -adjusted odds ratio [OR] 5.88, 95% confidence interval [CI] = 5.47 to 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 (>1 per month in the final year) demonstrating higher suicide risk compared with their counterparts who consulted once: females (adjusted OR 9.50, 95% CI = 7.82 to 11.54), patients aged 15-<45 years (adjusted OR 8.08, 95% CI = 7.29 to 8.96), patients experiencing less socioeconomic deprivation (adjusted OR 6.56, 95% CI = 5.77 to 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 most common reasons for which patients who died by suicide consulted in the year before death.

Conclusion: 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.

Keywords: consultation; family practice; general practice; primary health care; suicide.

Figure 1.

Comparison of rates of consultation with primary care professionals per annum among the case group and the control group in the 5 years before date of death by suicide. ^aFrequencies of consultations and rates have been calculated in the subset of individuals with complete data in the year being examined.

Figure 2.

Comparison of rates of consultations with primary health care per month among the case group and the control group in the year leading up to the date of death by suicide.