This report, published by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, examines aspects of primary healthcare prior to suicide to inform prevention.
This study extends previous work by:
- examining a representative sample of all primary care patients who died by suicide, not only those under mental health care,
- comparing these patients to other patients in primary care to identify markers of suicide risk, and
- examining data over a longer period (10 years).
The study aimed to:
- compare the number and pattern of GP contacts in patients who died by suicide and in living controls,
- determine how frequently suicide was preceded by mental health diagnosis, prescription of psychotropic medication and referral to specialist mental health care,
- identify possible markers of suicide risk in primary care.
- 37% of people who died by suicide had not seen their GP in the previous year. Risk was increased by 67% in non-attenders.
- Suicide risk also increased with increasing number of GP consultations, particularly in the 2 to 3 months prior to suicide. In those who attended more than 24 times, risk was increased 12-fold.
- 37% of those who died by suicide did not have a mental health diagnosis recorded on the database at any time.
- 52% had not been prescribed psychotropic drug treatment in the year before they died.
- Patients who died were more likely to be receiving psychotropic medication than living patients.
- Lithium was associated with a lower suicide risk than other groups of drugs; benzodiazepines were associated with a suicide risk equivalent to antidepressants.
- Being prescribed more than one type of drug was associated with an 11-fold increase in suicide risk.
- Only 8% of patients who died had been referred to specialist mental health services in the previous 12 months.
Key messages for services
- In primary care patients who die by suicide, mental illness is frequently unrecognised.
- Suicide risk is associated with frequent attendance, increasing attendance, and non-attendance.
- Markers of risk in those attending include frequent consultation, multiple psychotropic drugs, and specific drug combinations such as benzodiazepines with antidepressants.
- These markers could be the basis of a “flag” alert in primary care records, leading to further assessment.
- The current Health Check in primary care should be amended to include mental health, as a step to identifying risk in non-attenders.
- Suicide prevention in primary care non-attenders will have to rely on other agencies including the voluntary sector and internet based supports who may be better able to maintain contact with young people at risk.