Treatment of Mental Illness Prior to Suicide: A National Investigation of 12,909 patients, 2001–2016 (original) (raw)
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Access to health care prior to suicide: findings from a psychological autopsy study
The British journal of general practice : the journal of the Royal College of General Practitioners, 2004
Previous research has suggested that progress towards suicide reduction targets may be achieved by improving the ability of general practitioners to recognise and treat mental illness. Using data from a study of suicide completers who were not in contact with specialist mental health services, we found that the rate of detection and treatment of mental health problems in primary care was high. The major barrier to receipt of care for mental health problems prior to suicide was non-consultation. The study also shows that detection and management in primary care does not necessarily result in prevention of suicide. Implications for public education, access to primary care services and the potential for suicide prevention are considered.
Suicide within 12 months of mental health service contact in different age and diagnostic groups
British Journal of Psychiatry, 2006
BackgroundSuicide prevention is a health service priority but the most effective approaches to prevention may differ between different patient groups.AimsTo describe social and clinical characteristics in cases of suicide from different age and diagnostic groups.MethodA national clinical survey of a 4-year (1996–2000) sample of cases of suicide in England and Wales where there had been recent (< 1 year) contact with mental health services (n=4859).ResultsDeaths of young patients were characterised by jumping from a height or in front of a vehicle, schizophrenia, personality disorder, unemployment and substance misuse. In older patients, drowning, depression, living alone, physical illness, recent bereavement and suicide pacts were more common. People with schizophrenia were often in-patients and died by violent means. About athird of people with depressive disorder died within a year of illness onset. Those with substance dependence or personality disorder had high rates of disen...
GPs' views and perspectives on patient non-adherence to treatment in primary care prior to suicide
Journal of mental health (Abingdon, England), 2017
Individuals who do not adhere to their treatment regimens may be at greater risk of suicide but these issues are relatively unexplored in primary care services. To explore GPs' views and perspectives on the reasons why patients who were in contact with mental health services in the year prior to suicide was non-adherent to treatment prior to their death. In total, 198 semi-structured face-to-face interviews with GPs of people who had died by suicide. Interviews were transcribed verbatim and analyzed using a thematic approach. The following themes were conceptualized from GP interviews: (i) "Lack of insight or denial?" relates to what GPs perceived as their patients lack of insight into their psychiatric illness; (ii) "Lack of treatment choices" discusses GPs' understanding of patient treatment choices; (iii) "Services for comorbidity and dual diagnosis" refers to treatment availability for suicidal patients with two or more mental health diagnos...
Social Psychiatry and Psychiatric Epidemiology
Purpose There is limited research on the associations between factors relating to mental and physical health in people who died by suicide. Methods Consecutive suicide cases were included in a psychological autopsy study as part of the Suicide Support and Information System in southern Ireland. Chi-square tests and logistic regression analysis were used to examine factors associated with recorded presence or absence of mental and physical health problems. Results The total sample comprised 307 suicide cases, the majority being male (80.1%). Sixty-five percent had a history of self-harm and 34.6% of these cases had not been seen or treated following previous self-harm, although most (80.3%) had a history of recent GP attendance. Mental health diagnoses were present in 84.8% of cases where this variable was documented, and among these, 60.7% had a history of substance misuse and 30.6% had physical health problems. Variables associated with mental illness included gender, older age, previous self-harm episode(s), and presence of drugs in toxicology at time of death. Variables associated with physical illness included older age, death by means other than hanging, and previous self-harm episode(s). Conclusions Different factors associated with suicide were identified among people with mental and physical illness and those with and without a diagnosis, and need to be taken into account in suicide prevention. The identified factors highlight the importance of integrated care for dual-diagnosis presentations, restricting access to means, and early recognition and intervention for people with high-risk self-harm.
Suicide with psychiatric diagnosis and without utilization of psychiatric service
BMC Public Health, 2010
Background: Considerable attention has been focused on the study of suicides among those who have received help from healthcare providers. However, little is known about the profiles of suicide deceased who had psychiatric illnesses but made no contact with psychiatric services prior to their death. Behavioural model of health service use is applied to identify factors associated with the utilization of psychiatric service among the suicide deceased. Methods: With respect to completed suicide cases, who were diagnosed with a mental disorder, a comparison study was made between those who had (contact group; n = 52; 43.7%) and those who had not made any contact (non-contact group; n = 67; 56.3%) with a psychiatrist during the final six months prior to death. A sample of 119 deceased cases aged between 15 and 59 with at least one psychiatric diagnosis assessed by the Structured Clinical Interview for DSM-IV-TR (SCID I) were selected from a psychological autopsy study in Hong Kong. Results: The contact and non-contact group could be well distinguished from each other by "predisposing" variables: age group & gender, and most of the "enabling", and "need" variables tested in this study. Multiple logistic regression analysis has found four factors are statistically significantly associated with non-contact suicide deceased: (i) having non-psychotic disorders (OR = 13.5, 95% CI:2.9-62.9), (ii) unmanageable debts (OR = 10.5, CI:2.4-45.3), (iii) being full/partially/self employed at the time of death (OR = 10.0, CI:1.6-64.1) and (iv) having higher levels of social problem-solving ability (SPSI) (OR = 2.0, CI:1.1-3.6). Conclusion: The non-contact group was clearly different from the contact group and actually comprised a larger proportion of the suicide population that they could hardly be reached by usual individual-based suicide prevention efforts. For this reason, both universal and strategic suicide prevention measures need to be developed specifically in non-medical settings to reach out to this non-contact group in order to achieve better suicide prevention results.
Risk of suicide according to level of psychiatric treatment: a nationwide nested case–control study
Social Psychiatry and Psychiatric Epidemiology, 2014
Purpose Knowledge of the epidemiology of suicide is a necessary prerequisite of suicide prevention. We aimed to conduct a nationwide study investigating suicide risk in relation to level of psychiatric treatment. Methods Nationwide nested case-control study comparing individuals who died from suicide between 1996 and 2009 to age-, sex-, and year-matched controls. Psychiatric treatment in the previous year was graded as ''no treatment,'' ''medicated,'' ''outpatient contact,'' ''psychiatric emergency room contact,'' or ''admitted to psychiatric hospital.'' Results There were 2,429 cases and 50,323 controls. Compared with people who had not received any psychiatric treatment in the preceding year, the adjusted rate ratio (95 % confidence interval) for suicide was 5.8 (5.2-6.6) for people receiving only psychiatric medication, 8.2 (6.1-11.0) for people with at most psychiatric outpatient contact, 27.9 (19.5-40.0) for people with at most psychiatric emergency room contacts, and 44.3 (36.1-54.4) for people who had been admitted to a psychiatric hospital. The gradient was steeper for married or cohabiting people, those with higher socioeconomic position, and possibly those without a history of attempted suicide. Conclusions Psychiatric admission in the preceding year was highly associated with risk of dying from suicide. Furthermore, even individuals who have been in contact with psychiatric treatment but who have not been admitted are at highly increased risk of suicide.
Psychiatric in-patient care and suicide in England, 1997 to 2008: a longitudinal study
Psychological Medicine, 2012
BackgroundPsychiatric in-patients are at high risk of suicide. Recent reductions in bed numbers in many countries may have affected this risk but few studies have specifically investigated temporal trends. We aimed to explore trends in psychiatric in-patient suicide over time.MethodA prospective study of all patients admitted to National Health Service (NHS) in-patient psychiatric care in England (1997–2008). Suicide rates were determined using National Confidential Inquiry and Hospital Episode Statistics (HES) data.ResultsOver the study period there were 1942 psychiatric in-patient suicides. Between the first 2 years of the study (1997, 1998) and the last 2 years (2007, 2008) the rate of in-patient suicide fell by nearly one-third from 2.45 to 1.68 per 100 000 bed days. This fall in rate was observed for males and females, across ethnicities and diagnoses. It was most marked for patients aged 15–44 years. Rates also fell for the most common suicide methods, particularly suicide by ...
Personal experience: Suicide and psychiatric care - a lament
BJPsych bulletin, 2015
A personal bereavement from suicide prompts a critique of current mental healthcare. Fragmentation, lack of long-term attachment to a tenured professional, the dearth of family therapy, and professional ambivalence are identified as weaknesses in current provision. Implicit is the case for change in UK psychiatric services, both structural (need for long-term therapies) and cultural (need for a mentalising rather than protocol-driven, 'choice'-led ethos).
Suicide and mortality related to mental disorder in three Swedish cohorts
year: 2010, 2010
Aims The subject of this thesis is suicide and other premature death related to mental disorder. The overall aim is to provide knowledge to improve prevention strategies. The specific aims are as follows: Study I: To identify predictors of suicide in a cohort with long-term mental disorder. Study II: To analyse mortality by mental health service and psychiatric diagnosis in a cohort with long-term mental disorder. Study III: To investigate the impact of psychiatric morbidity on suicide risk following a suicide attempt. Study IV: To examine familial suicide risks in a total population sample. Methods Studies I and II: Adult residents with mental disorder in Stockholm County, Sweden, were identified in 1997. This register (n=12,247) was linked to national registers. Discharges from psychiatric inpatient care during 1990-2000 and deaths during 1997-2000 were identified. Predictors of suicide in the cohort were investigated; standardised mortality ratios were calculated. Study III: Data on all people living in Sweden 1973-82 were linked to national registers. People hospitalised during the period 1973-82 due to attempted suicide were identified. The cohort (n=39,685) consisted of those with a studied psychiatric diagnosis present at index attempt (cases) and those without a psychiatric diagnosis within a year after the suicide attempt (reference subjects). Patients were followed for 21-31 years. Survival curves for suicide were plotted and hazard ratios computed. Study IV: A population-based cohort (n=7,969,645) was created by linkage of Swedish national registers. Persons with death classified as definite or uncertain suicide 1952-2003 were identified (n=83,951). Odds ratios for suicide in relatives of suicide probands were calculated in relation to relatives of controls. Results Study I: Predictors of suicide included previous suicide attempt, a history of psychiatric inpatient care, and unmet need of a contact person. Borderline personality disorder was the strongest diagnostic predictor. Study II: Excess mortality was greater among those with a history of psychiatric inpatient care. The number of excess deaths due to natural causes was threefold that due to external causes. Study III: High proportions of suicides in all diagnostic groups took place within one year. The strongest predictors of completed suicide throughout the entire follow-up were schizophrenia and bipolar/unipolar disorder, with up to 39% suicide mortality. Study IV: The risk increase was threefold in full-siblings and twofold in children. The odds ratio for full-siblings was higher than that for maternal half-siblings. Odds ratios for second-and third-degree relatives were similar. Partners of suicide probands had a higher odds ratio than most biological relatives. Conclusions Treatment programs for persons with long-term mental disorder should target both physical and mental health. Unmet needs may signal increased suicide risk in persons with mental disorder. Psychiatric case management should focus on more intensive aftercare during the first years after a suicide attempt in patients with bipolar and unipolar disorder or schizophrenia. The findings of Study IV are not entirely consistent with variance by degree of genetic correlation; the study could identify impact of both shared environment and shared genes in familial transmission of suicidal behaviour.