University of Manchester, Centre for Suicide Prevention, Manchester.
Br J Gen Pract. 2009 Nov;59(568):825-32. doi: 10.3399/bjgp09X472881.
Previous studies have reported differing rates of consultation with GPs prior to suicide. Patients with a psychiatric history have higher rates of consultation and consult closer to the time of their death.
To investigate the frequency and nature of general practice consultations in the year before suicide for patients in current, or recent, contact with secondary mental health services.
Retrospective case-note study and semi-structured interviews.
General practices in the northwest of England.
General practice data were obtained by a retrospective review of medical records (n = 247) and semi-structured interviews with GPs (n = 159).
GP records were reviewed in 247 of the 286 cases (86%). Overall, 91% of individuals (n = 224) consulted their GP on at least one occasion in the year before death. The median number of consultations was 7 (interquartile range = 3-10). Interviews were carried out with GPs with regard to 159 patients. GPs reported concerns about their patient's safety in 43 (27%) cases, but only 16% of them thought that the suicide could have been prevented. Agreement between GPs and mental health teams regarding risk of suicide was poor. Both sets of clinicians rated moderate to high levels of risk in only 3% of cases for whom information was available (n = 139) (overall kappa = 0.024).
Consultation prior to suicide is common but suicide prevention in primary care is challenging. Possible strategies might include examining the potential benefits of risk assessment and collaborative working between primary and secondary care.
先前的研究报告了自杀前与全科医生（GP）咨询的比例存在差异。有精神病史的患者咨询率更高，且更接近死亡时间进行咨询。
调查目前或近期接触二级精神卫生服务的患者在自杀前一年到全科医生处就诊的频率和性质。
回顾性病历研究和半结构化访谈。
英格兰西北部的全科医生诊所。
通过对医疗记录的回顾性审查（n=247）和对全科医生的半结构化访谈（n=159）获得全科医生的数据。
在 286 例病例中，有 247 例（86%）的 GP 记录被审查。总体而言，91%的个体（n=224）在死亡前一年至少有一次就诊。中位数就诊次数为 7（四分位距=3-10）。对 159 名患者进行了与 GP 的访谈。有 43 名（27%）GP 报告了对患者安全的担忧，但只有 16%的人认为自杀可以预防。全科医生和精神卫生团队对自杀风险的评估意见不一致。两组临床医生仅在可获得信息的 139 例病例（n=139）中对 3%的病例评估为中度至高度风险（总体kappa=0.024）。
自杀前的咨询很常见，但初级保健中的自杀预防具有挑战性。可能的策略包括评估风险评估的潜在益处以及初级保健和二级保健之间的协作工作。
