title: Trends from the surveillance of suicidal behaviour by the Belgian Network of Sentinel General Practices over two decades: a retrospective observational study.
abstract: OBJECTIVE
  First, we describe trends in characteristics of suicidal events using new (2011-2012) and previous (1993-1995, 2000-2001 and 2007-2008) data reported by the Belgian Network of Sentinel General Practices (SGP); second, we examine patient age-related trends in on-site attendance of sentinel general practitioners (GPs) as first professional caregivers following suicidal behaviour; third, we investigate the accuracy of suicide incidence estimates derived from the SGP data.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  General practices from the nationwide representative Belgian Network of SGP.
  
  
  METHODS
  Patient gender and age, suicide methods, whether the patient was new, whether the GP was the first caregiver on-site, and the outcome of the suicidal behaviour (fatal or not) were recorded on standard registration forms. The accuracy of suicide incidence estimates was tested against suicide mortality data.
  
  
  RESULTS
  Over the four time periods, 1671 suicidal events were reported: 275 suicides, 1287 suicide attempts and 109 events of suicidal behaviour of unknown outcome. In 2011-2012, sentinel GPs' on-site attendance following the suicidal behaviour of patients <65 years had continued to decrease (from 71% in 1993-1995 to 58% in 2000-2001, 39% in 2007-2008 and 25% in 2011-2012). In 2011-2012, it had also decreased steeply in the population ≥65 years (from 70% in 1993-1995, 76% in 2000-2001 and 79% in 2007-2008 to 35% in 2011-2012). No significant differences were found between the SGP-based suicide incidence estimates for 2011-2012 and the available suicide mortality rates for people <65 and ≥65 years.
  
  
  CONCLUSIONS
  GPs' on-site attendance as first professional caregivers following suicidal behaviour continues to decline since 2011-2012 also in the population ≥65 years. Unawareness of patients' suicidal behaviour endangers both care for surviving patients and the completeness of SGP surveillance data. Yet, the incidence of suicide for 2011-2012 was estimated accurately by the SGP.
authors.affiliation: Scientific Institute of Public Health, OD Public Health and Surveillance, Brussels, Belgium.
authors.forename: Nicole
authors.initials: N
authors.lastname: Boffin
authors.affiliation: Scientific Institute of Public Health, OD Public Health and Surveillance, Brussels, Belgium.
authors.forename: Sarah
authors.initials: S
authors.lastname: Moreels
authors.affiliation: Scientific Institute of Public Health, OD Public Health and Surveillance, Brussels, Belgium.
authors.forename: Viviane
authors.initials: V
authors.lastname: Van Casteren
mesh_terms: D000368:Aged; D001530:Belgium / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D005544:Forecasting; D058006:General Practice / Q000458:organization & administration*; D058005:General Practitioners; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data / Q000639:trends*; D013406:Suicide, Attempted / Q000706:statistics & numerical data / Q000639:trends*
keywords: EPIDEMIOLOGY; PUBLIC HEALTH