title: Patterns and predictors of help-seeking contacts with health services and general practitioner detection of suicidality prior to suicide: a cohort analysis of suicides occurring over a two-year period.
abstract: BACKGROUND
  Contact with primary care and psychiatric services prior to suicide may be considerable, presenting opportunities for intervention. However, there is scant knowledge on the frequency, nature and determinants of contact.
  
  
  METHODS
  Retrospective cohort study-an analysis of deaths recorded as suicide by the Northern Ireland Coroner's Office linked with data from General Practice patient records over a 2 year period
  
  
  RESULTS
  Eighty-seven per cent of suicides were in contact with General Practice services in the 12 months before suicide. The frequency of contact with services was considerable, particularly among patients with a common mental disorder or substance misuse problems. A diagnosis of psychiatric problems was absent in 40% of suicides. Excluding suicide attempts, the main predictors of a noted general practitioner concern for patient suicidality are male gender, frequency of consultations, diagnosis of mental illness and substance misuse.
  
  
  CONCLUSIONS
  Despite widespread and frequent contact, a substantial proportion of suicidal people were undiagnosed and untreated for mental health problems. General Practitioner alertness to suicidality may be too narrowly focused.
authors.affiliation: Bamford Centre for Mental Health & Wellbeing, Ulster University, Cromore Road, Coleraine, BT52 1SA, Londonderry, Northern Ireland. g.leavey@ulster.ac.uk.
authors.forename: Gerard
authors.initials: G
authors.lastname: Leavey
authors.affiliation: Bamford Centre for Mental Health & Wellbeing, Ulster University, Cromore Road, Coleraine, BT52 1SA, Londonderry, Northern Ireland.
authors.forename: Michael
authors.initials: M
authors.lastname: Rosato
authors.affiliation: School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Building, 97 Lisburn Road, Belfast, BT 9 7BL, Northern Ireland.
authors.forename: Karen
authors.initials: K
authors.lastname: Galway
authors.affiliation: Bamford Centre for Mental Health & Wellbeing, Ulster University, Cromore Road, Coleraine, BT52 1SA, Londonderry, Northern Ireland.
authors.forename: Lynette
authors.initials: L
authors.lastname: Hughes
authors.affiliation: Faculty of Health and Social Care, Horlock Building, Open University, Milton Keynes, MK7 6AA, Northern Ireland.
authors.forename: Sharon
authors.initials: S
authors.lastname: Mallon
authors.affiliation: Bamford Centre for Mental Health & Wellbeing, Ulster University, Cromore Road, Coleraine, BT52 1SA, Londonderry, Northern Ireland.
authors.forename: Janeet
authors.initials: J
authors.lastname: Rondon
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D058005:General Practitioners; D000066505:Help-Seeking Behavior; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis*; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D009660:Northern Ireland; D011320:Primary Health Care; D012189:Retrospective Studies; D013405:Suicide / Q000706:statistics & numerical data*
keywords: General practice; Health services; Help-seeking; Suicidality; Suicide predictors