PDF(Pubmed)
Abstract：
BACKGROUND: Consultation with primary healthcare professionals may provide an opportunity to identify patients at higher suicide risk.
OBJECTIVE: To explore primary care consultation patterns in the 5 years before suicide to identify suicide high-risk groups and common reasons for consulting.
METHODS: This was a case-control study using electronic health records from England, 2001 to 2019.
METHODS: An analysis was undertaken of 14 515 patients aged ≥15 years who died by suicide and up to 40 matched live controls per person who died by suicide (n = 580 159), (N = 594 674).
RESULTS: Frequent consultations (>1 per month in the final year) were associated with increased suicide risk (age- and sex -adjusted odds ratio [OR] 5.88, 95% confidence interval [CI] = 5.47 to 6.32). The associated rise in suicide risk was seen across all sociodemographic groups as well as in those with and without psychiatric comorbidities. However, specific groups were more influenced by the effect of high-frequency consultation (>1 per month in the final year) demonstrating higher suicide risk compared with their counterparts who consulted once: females (adjusted OR 9.50, 95% CI = 7.82 to 11.54), patients aged 15-<45 years (adjusted OR 8.08, 95% CI = 7.29 to 8.96), patients experiencing less socioeconomic deprivation (adjusted OR 6.56, 95% CI = 5.77 to 7.46), and those with psychiatric conditions (adjusted OR 4.57, 95% CI = 4.12 to 5.06). Medication review, depression, and pain were the most common reasons for which patients who died by suicide consulted in the year before death.
CONCLUSIONS: Escalating or more than monthly consultations are associated with increased suicide risk regardless of patients\' sociodemographic characteristics and regardless of the presence (or absence) of known psychiatric illnesses.
OBJECTIVE: To explore primary care consultation patterns in the 5 years before suicide to identify suicide high-risk groups and common reasons for consulting.
METHODS: This was a case-control study using electronic health records from England, 2001 to 2019.
METHODS: An analysis was undertaken of 14 515 patients aged ≥15 years who died by suicide and up to 40 matched live controls per person who died by suicide (n = 580 159), (N = 594 674).
RESULTS: Frequent consultations (>1 per month in the final year) were associated with increased suicide risk (age- and sex -adjusted odds ratio [OR] 5.88, 95% confidence interval [CI] = 5.47 to 6.32). The associated rise in suicide risk was seen across all sociodemographic groups as well as in those with and without psychiatric comorbidities. However, specific groups were more influenced by the effect of high-frequency consultation (>1 per month in the final year) demonstrating higher suicide risk compared with their counterparts who consulted once: females (adjusted OR 9.50, 95% CI = 7.82 to 11.54), patients aged 15-<45 years (adjusted OR 8.08, 95% CI = 7.29 to 8.96), patients experiencing less socioeconomic deprivation (adjusted OR 6.56, 95% CI = 5.77 to 7.46), and those with psychiatric conditions (adjusted OR 4.57, 95% CI = 4.12 to 5.06). Medication review, depression, and pain were the most common reasons for which patients who died by suicide consulted in the year before death.
CONCLUSIONS: Escalating or more than monthly consultations are associated with increased suicide risk regardless of patients\' sociodemographic characteristics and regardless of the presence (or absence) of known psychiatric illnesses.
摘要：
背景：与初级卫生保健机构会诊可能为确定自杀风险较高的患者提供了机会。
目的：探讨自杀前5年的初级保健咨询模式，确定自杀高危人群及常见咨询原因。
方法：2001年至2019年在英格兰使用电子健康记录的病例对照研究。
方法：分析14515例年龄≥15岁的自杀死亡患者和多达40例匹配的活体对照（N=594674）。
结果：频繁会诊（最后一年每月一次）与自杀风险增加相关（年龄和性别调整比值比（OR）5.88；95％CI：5.47-6.32）。在所有社会人口统计学群体以及有和没有精神病合并症的人群中，自杀风险的相关上升都可见。然而,与曾经咨询过的同类人群相比,特定人群受到高频咨询(最后一年每月>一次)效果的影响更大,这表明自杀风险更高:女性(调整后OR9.50;95%CI:7.82~11.54);年龄在15~45岁的患者(调整后OR8.08;95%CI:7.29~8.96);社会经济剥夺程度较低的患者(调整后OR6.56;95%CI:5.77~7.46);药物审查，抑郁和疼痛是自杀死者在死亡前一年咨询的最常见原因。
结论：不断升级，无论患者的社会人口统计学特征以及是否存在（或不存在）已知的精神疾病，或超过每月一次的咨询都会增加自杀风险。
目的：探讨自杀前5年的初级保健咨询模式，确定自杀高危人群及常见咨询原因。
方法：2001年至2019年在英格兰使用电子健康记录的病例对照研究。
方法：分析14515例年龄≥15岁的自杀死亡患者和多达40例匹配的活体对照（N=594674）。
结果：频繁会诊（最后一年每月一次）与自杀风险增加相关（年龄和性别调整比值比（OR）5.88；95％CI：5.47-6.32）。在所有社会人口统计学群体以及有和没有精神病合并症的人群中，自杀风险的相关上升都可见。然而,与曾经咨询过的同类人群相比,特定人群受到高频咨询(最后一年每月>一次)效果的影响更大,这表明自杀风险更高:女性(调整后OR9.50;95%CI:7.82~11.54);年龄在15~45岁的患者(调整后OR8.08;95%CI:7.29~8.96);社会经济剥夺程度较低的患者(调整后OR6.56;95%CI:5.77~7.46);药物审查，抑郁和疼痛是自杀死者在死亡前一年咨询的最常见原因。
结论：不断升级，无论患者的社会人口统计学特征以及是否存在（或不存在）已知的精神疾病，或超过每月一次的咨询都会增加自杀风险。
