title: Service contacts prior to death in people dying by suicide in the Scottish Highlands.
abstract: BACKGROUND
  Many people who die by suicide have been in contact with health services prior to their death. This study examined service contacts in people in urban and rural areas of the Scottish Highlands.
  
  
  METHODS
  Highland residents dying by suicide or undetermined intent in 2001-2004 were identified using routine death records. Health service databases were searched to identify general hospital, mental health and general practice notes.
  
  
  RESULTS
  177 residents died in the time period (136 males). At least one type of record was identified on 175 people, including general practice records (167 people, 94.4%), psychiatric hospital records (n=87, 49.2%) and general hospital records (n=142, 80.2%). Of these, 52.5% had been in contact with at least one health service in the month before their death, including 18.6% with mental health services, and 46.4% with general practice. In total, 68.9% had a previous diagnosis of mental illness, 52.5% of substance misuse problems, and 40.1% of self-harm. The commonest mental illness diagnosis was depression (n=97, 54.8%). There was no difference in rates of GP contact in rural and urban areas. Of those dying in urban areas, 32% had been in contact with mental health services in the previous month, compared with 21% in Accessible Rural/Accessible Small Towns, and 11% in Remote Rural/Remote Small Towns (p<0.01). People in rural areas were less likely to have had contact with mental health services in the year before their death (p<0.01), and to have had lower recorded lifetime rates of mental health service contact (p<0.001), deliberate self-harm (p<0.005) and mental illness (p<0.001).
  
  
  CONCLUSIONS
  Overall service contact rates prior to death by suicide were very similar to the results of a previous meta-analysis. Rates of contact with specialist mental health services were significantly lower in rural than urban areas, and this finding increased with greater rurality.
authors.affiliation: NHS Highland, Inverness, Scotland, UK. cameron.stark@nhs.net
authors.forename: Cameron R
authors.initials: CR
authors.lastname: Stark
authors.forename: Susan
authors.initials: S
authors.lastname: Vaughan
authors.forename: Sara
authors.initials: S
authors.lastname: Huc
authors.forename: Noelle
authors.initials: N
authors.lastname: O'Neill
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005194:Family Practice; D005260:Female; D006769:Hospitals, General; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D012606:Scotland / Q000453:epidemiology; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D019966:Substance-Related Disorders / Q000401:mortality / Q000628:therapy; D013405:Suicide / Q000706:statistics & numerical data* / Q000639:trends; D013997:Time Factors; D014505:Urban Population / Q000706:statistics & numerical data*