Research department, 113 Suicide Prevention, Amsterdam, Netherlands; Psychiatry, Amsterdam Public Health (research institute), Amsterdam UMC VU University, Amsterdam, Netherlands.
Department of epidemiology, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, Netherlands.
J Affect Disord. 2021 May 15;287:158-164. doi: 10.1016/j.jad.2021.03.014. Epub 2021 Mar 13.
This study aimed to establish differences between suicide decedents and a reference population across various health care settings.
This population-wide registration study combined death statistics, sociodemographic data and health care data from Statistics Netherlands. From 2010 to 2016, 12,015 suicide cases and a random reference group of 132,504 were included and assigned to one of the three health care settings; mental health (MH) care, primary care or no care. Logistic regression analyses were performed to determine differences in suicide risk factors across settings.
In the 1-2 year period before suicide, 52% of the suicide decedents received MH care, 41% received GP care only and 7% received neither. Although sociodemographic factors showed significant differences across settings, the suicide risk profiles were not profoundly distinctive. A decreasing trend in suicide risk across health care settings became apparent for male gender, income level and being in a one-person or one-parent household, whereas for other factors (middle and older age, non-Western migration background, couples without children and people living in more sparsely populated areas), risk of suicide increased when health care setting became more specialized.
Because of the data structure, 18 months of suicide decedents' health care use were compared with two years health care use of the reference group, which likely led to an underestimation of the reported differences.
Although there are differences between suicide decedents and a reference group across health care settings, these are not sufficiently distinctive to advocate for a setting-specific approach to suicide prevention.
本研究旨在确定不同医疗保健环境下自杀死者与参考人群之间的差异。
本全人群登记研究结合了荷兰统计局的死亡统计数据、社会人口统计学数据和医疗保健数据。2010 年至 2016 年，共纳入 12015 例自杀病例和 132504 名随机对照人群，并将其分配到三个医疗保健环境之一：精神卫生（MH）保健、初级保健或无保健。采用逻辑回归分析确定各环境中自杀风险因素的差异。
在自杀前 1-2 年期间，52%的自杀死者接受了 MH 护理，41%仅接受了全科医生护理，7%两者均未接受。尽管社会人口学因素在各环境之间存在显著差异，但自杀风险特征并无明显差异。男性、收入水平和一人或单亲家庭的自杀风险呈下降趋势，而对于其他因素（中年和老年、非西方移民背景、无子女的夫妇和居住在人口稀少地区的人），随着医疗保健环境变得更加专业化，自杀风险增加。
由于数据结构的原因，将自杀死者 18 个月的医疗保健使用情况与对照组两年的医疗保健使用情况进行了比较，这可能导致报告的差异被低估。
尽管在医疗保健环境中自杀死者与对照组之间存在差异，但这些差异不足以支持针对特定环境的自杀预防方法。
