title: Attendance at the accident and emergency department in the year before suicide: retrospective study.
abstract: BACKGROUND
  The National Confidential Inquiry into suicides in England and Wales found that a quarter of suicides are preceded by mental health service contact in the year before death. However, visits to accident and emergency departments due to self-harm may not lead to a record of mental health service contact. Aims To determine the proportion of suicides preceded by accident and emergency attendance in the previous year.
  
  
  METHODS
  We obtained the list of probable suicides in Leeds for a 38-month period, and examined the records from the city's accident and emergency departments for a year before each death.
  
  
  RESULTS
  Eighty-five (39%) of the 219 people who later died by suicide had attended an accident and emergency department in the year before death, 15% because of non-fatal self-harm. Final visits due to self-harm were often shortly before suicide (median 38 days), but the National Confidential Inquiry recorded about a fifth of them as 'not in contact' with local mental health services.
  
  
  CONCLUSIONS
  Although many suicides are preceded by recent attendance at accident and emergency departments due to non-fatal self-harm, local mental health service records may show no recent contact. Suicide prevention might be enhanced were accident and emergency departments and mental health services to work together more closely.
authors.affiliation: Yorkshire Centre for Forensic Psychiatry, Wakefield. Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, UK.
authors.forename: Isaura
authors.initials: I
authors.lastname: Gairin
authors.forename: Allan
authors.initials: A
authors.lastname: House
authors.forename: David
authors.initials: D
authors.lastname: Owens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D012306:Risk; D016728:Self-Injurious Behavior / Q000523:psychology* / Q000628:therapy; D013405:Suicide