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Abstract：
Little is known about the precursors of suicide risk among primary-care patients. This study aimed to examine suicide risk in relation to patterns of clinical consultation, psychotropic drug prescribing, and psychiatric diagnoses.
Nested case-control study in the Clinical Practice Research Datalink (CPRD), England. Patients aged ⩾16 years who died by suicide during 2002-2011 (N = 2384) were matched on gender, age and practice with up to 20 living control patients (N = 46 899).
Risk was raised among non-consulting patients, and increased sharply with rising number of consultations in the preceding year [⩾12 consultations v. 1: unadjusted odds ratio (OR) 6.0, 95% confidence interval (CI) 4.9-7.3]. Markedly elevated risk was also associated with the prescribing of multiple psychotropic medication types (⩾5 types v. 0: OR 62.6, CI 44.3-88.4) and with having several psychiatric diagnoses (⩾4 diagnoses v. 0: OR 31.1, CI 19.3-50.1). Risk was also raised among patients living in more socially deprived localities. The confounding effect of multiple psychotropic drug types largely accounted for the rising risk gradient observed with increasing consultation frequency.
A greater proportion of patients with several psychiatric diagnoses, those prescribed multiple psychotropic medication types, and those who consult at very high frequency might be considered for referral to mental health services by their general practitioners. Non-consulters are also at increased risk, which suggests that conventional models of primary care may not be effective in meeting the needs of all people in the community experiencing major psychosocial difficulties.
Nested case-control study in the Clinical Practice Research Datalink (CPRD), England. Patients aged ⩾16 years who died by suicide during 2002-2011 (N = 2384) were matched on gender, age and practice with up to 20 living control patients (N = 46 899).
Risk was raised among non-consulting patients, and increased sharply with rising number of consultations in the preceding year [⩾12 consultations v. 1: unadjusted odds ratio (OR) 6.0, 95% confidence interval (CI) 4.9-7.3]. Markedly elevated risk was also associated with the prescribing of multiple psychotropic medication types (⩾5 types v. 0: OR 62.6, CI 44.3-88.4) and with having several psychiatric diagnoses (⩾4 diagnoses v. 0: OR 31.1, CI 19.3-50.1). Risk was also raised among patients living in more socially deprived localities. The confounding effect of multiple psychotropic drug types largely accounted for the rising risk gradient observed with increasing consultation frequency.
A greater proportion of patients with several psychiatric diagnoses, those prescribed multiple psychotropic medication types, and those who consult at very high frequency might be considered for referral to mental health services by their general practitioners. Non-consulters are also at increased risk, which suggests that conventional models of primary care may not be effective in meeting the needs of all people in the community experiencing major psychosocial difficulties.
摘要：
关于初级保健患者自杀风险的前兆知之甚少。这项研究旨在检查自杀风险与临床咨询模式的关系，精神药物处方，和精神病诊断。
临床实践研究数据链（CPRD）中的嵌套病例对照研究，英格兰。2002-2011年期间因自杀而死亡的16岁患者（N=2384）在性别上进行匹配，年龄和实践与多达20个生活控制患者（N=46899）。
非咨询患者的风险增加，andincreasedsharelywithincreasingnumberofconsultationsinthepurchingyear[I.12consultationsv.1:unadjustedoddsratio(OR)6.0,95%confidenceinterval(CI)4.9-7.3].明显升高的风险还与多种精神药物类型的处方有关（5种类型v.0：OR62.6，CI44.3-88.4），并与几种精神病诊断有关（4诊断v.0：OR31.1，CI19.3-50.1）。生活在社会贫困地区的患者也增加了风险。多种精神药物类型的混杂效应在很大程度上解释了随着咨询频率的增加而观察到的风险梯度上升。
有几种精神病诊断的患者比例更高，那些开了多种精神药物的人，那些以非常高的频率咨询的人可能会被其全科医生考虑转介给心理健康服务。非咨询者的风险也在增加，这表明，初级保健的传统模式可能无法有效地满足社区中经历重大社会心理困难的所有人的需求。
临床实践研究数据链（CPRD）中的嵌套病例对照研究，英格兰。2002-2011年期间因自杀而死亡的16岁患者（N=2384）在性别上进行匹配，年龄和实践与多达20个生活控制患者（N=46899）。
非咨询患者的风险增加，andincreasedsharelywithincreasingnumberofconsultationsinthepurchingyear[I.12consultationsv.1:unadjustedoddsratio(OR)6.0,95%confidenceinterval(CI)4.9-7.3].明显升高的风险还与多种精神药物类型的处方有关（5种类型v.0：OR62.6，CI44.3-88.4），并与几种精神病诊断有关（4诊断v.0：OR31.1，CI19.3-50.1）。生活在社会贫困地区的患者也增加了风险。多种精神药物类型的混杂效应在很大程度上解释了随着咨询频率的增加而观察到的风险梯度上升。
有几种精神病诊断的患者比例更高，那些开了多种精神药物的人，那些以非常高的频率咨询的人可能会被其全科医生考虑转介给心理健康服务。非咨询者的风险也在增加，这表明，初级保健的传统模式可能无法有效地满足社区中经历重大社会心理困难的所有人的需求。
