National Confidential Inquiry Into Suicide and Safety in Mental Health (NCISH), University of Manchester, Manchester, United Kingdom (Gianatsi, Hunt, Ibrahim, Windfuhr, While, Appleby, Kapur); Royal Bolton Hospital, Bolton National Health Service (NHS) Foundation Trust, Farnworth, United Kingdom (Burns); National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Manchester, United Kingdom (Kapur).
Psychiatr Serv. 2020 Aug 1;71(8):772-778. doi: 10.1176/appi.ps.201900452. Epub 2020 Apr 28.
Previous research suggests that up to 90% of individuals who die by suicide may have a mental disorder at the time of death but that levels of treatment may be low. This study aimed to examine undertreatment among patients with mental health conditions who died by suicide and to assess the association between patients' clinical and sociodemographic characteristics and treatment receipt.
The study's sample included 12,909 patients in England and Wales who died by suicide within 12 months of contact with mental health services between 2001 and 2016. All patients had received a diagnosis of bipolar affective disorder, schizophrenia, depression, or an anxiety disorder. Records of patients who were not receiving treatment as recommended by national clinical guidelines at the time of death were examined for levels of nonprescription of treatment and nonadherence.
Twenty-four percent of the patients did not receive treatment, 11% had not been prescribed treatment, and 13% were nonadherent with treatment. These proportions differed by diagnosis. After adjustment for main primary diagnosis, analyses showed that being under age 40, unemployment, living alone, drug misuse, medication side effects, and comorbid personality disorder were independently associated with a decreased likelihood of receiving treatment.
One-quarter of patients with mental health conditions who die by suicide may not be receiving relevant interventions at the time of death. Levels of and reasons for nontreatment vary by diagnosis, but measures to address comorbid diagnoses and implement interventions to improve adherence in specific groups could have an impact.
先前的研究表明，在死亡时患有精神障碍的自杀者可能高达 90%，但治疗水平可能较低。本研究旨在调查患有精神健康状况且自杀死亡的患者中治疗不足的情况，并评估患者的临床和社会人口统计学特征与治疗接受情况之间的关系。
本研究的样本包括 2001 年至 2016 年间在与精神卫生服务接触后 12 个月内自杀的英格兰和威尔士的 12909 名患者。所有患者均被诊断为双相情感障碍、精神分裂症、抑郁症或焦虑症。检查了在死亡时未按照国家临床指南接受治疗的患者记录，以了解治疗方案的非处方和不依从情况。
24%的患者未接受治疗，11%未开处方治疗，13%不遵守治疗方案。这些比例因诊断而异。在调整主要原发性诊断后，分析表明，年龄在 40 岁以下、失业、独居、药物滥用、药物副作用和合并人格障碍与接受治疗的可能性降低独立相关。
四分之一患有精神健康状况且自杀死亡的患者在死亡时可能未接受相关干预措施。不治疗的程度和原因因诊断而异，但采取措施解决合并诊断并实施干预措施以提高特定人群的依从性可能会产生影响。
