Haste F, Charlton J, Jenkins R
Barking and Havering Health Authority.
Br J Gen Pract. 1998 Nov;48(436):1759-63.
General practitioners (GPs) need to be aware of the risk factors for suicide. GP records may provide clues to identifying the relative importance of such risk factors.
To identify, in suicide cases and matched controls, the patterns of consultation, diagnosis, and treatment of mental illness, and recording of risk factors for suicide. To examine the usefulness of data routinely collected by GPs in computerized databases to investigate treatment of patients in general practice prior to suicide.
Case control study using GP records from the General Practice Research Database (GPRD). Three controls selected for each case, matched for age, sex, and duration of registration with practice. Information extracted of the prevalence of major disease; diagnosis of, and treatment, or referral for, mental illness; frequency of recording of recent life events; and consultations with the GP in the 12 months prior to death.
Of the 339 suicide cases recorded, 80% were male, which is similar to the national percentage for this age group. Females were more likely than males to have a history of mental illness and to have been diagnosed and treated for mental illness in the 12 months before death (59% versus 35%), and women were more likely to have previously attempted suicide (47% versus 27%). There was no significant difference between males and females in period of time since last contact with GP practice, but females consulted more frequently. Twenty-nine per cent of cases had not consulted their GP in the six months prior to death. In multivariate analysis, the following were identified as independent risk factors: history of attempted suicide; untreated serious mental illness (odds ratio > 20); recent (past 12 months) marital life event; alcohol abuse; frequent consultations with GP; and previous mental illness. Recording of life events by GPs was poor.
Females at risk of suicide are more likely than males to have been diagnosed and treated for mental illness. It is likely that GPs are under-diagnosed and under-treating males at risk. Data from the GPRD give comparable results to those from other studies. The GPRD is a potentially useful tool for research into relatively uncommon events in general practice.
全科医生（GP）需要了解自杀的风险因素。全科医生的记录可能为确定这些风险因素的相对重要性提供线索。
在自杀病例及匹配的对照中，确定精神疾病的诊疗模式以及自杀风险因素的记录情况。研究全科医生在计算机化数据库中常规收集的数据对于调查自杀前患者在全科医疗中的治疗情况的有用性。
采用来自全科医疗研究数据库（GPRD）的全科医生记录进行病例对照研究。为每个病例选取3名对照，根据年龄、性别和在诊所注册时长进行匹配。提取的信息包括主要疾病的患病率；精神疾病的诊断、治疗或转诊情况；近期生活事件的记录频率；以及死亡前12个月内与全科医生的会诊情况。
记录的339例自杀病例中，80%为男性，这与该年龄组的全国比例相似。女性比男性更有可能有精神疾病史，且在死亡前12个月内被诊断并接受过精神疾病治疗（59%对35%），女性也更有可能曾尝试自杀（47%对27%）。男性和女性自上次与全科医生诊所接触以来的时间没有显著差异，但女性就诊更频繁。29%的病例在死亡前6个月内未咨询过全科医生。多变量分析中，以下因素被确定为独立风险因素：自杀未遂史；未治疗的严重精神疾病（比值比>20）；近期（过去12个月）婚姻生活事件；酗酒；频繁咨询全科医生；以及既往精神疾病史。全科医生对生活事件的记录较差。
有自杀风险的女性比男性更有可能被诊断并接受精神疾病治疗。全科医生可能对有风险的男性诊断不足且治疗不足。GPRD的数据与其他研究结果具有可比性。GPRD是研究全科医疗中相对罕见事件的潜在有用工具。
