Primary care contact prior to suicide in individuals with mental illness.
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.


OBJECTIVE
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.


METHODS
Retrospective case-note study and semi-structured interviews.


METHODS
General practices in the northwest of England.


METHODS
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).


CONCLUSIONS
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.
University of Manchester, Centre for Suicide Prevention, Manchester. anna.m.pearson@manchester.ac.uk
Anna
A
Pearson
Pooja
P
Saini
Damian
D
Da Cruz
Caroline
C
Miles
David
D
While
Nicola
N
Swinson
Alyson
A
Williams
Jenny
J
Shaw
Louis
L
Appleby
Navneet
N
Kapur
D000328:Adult; D000368:Aged; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data*