Arch Suicide Res. 2022 Jul-Sep;26(3):1395-1409. doi: 10.1080/13811118.2021.1911894. Epub 2021 Apr 24.
To characterize people who died by suicide after having previous contacts with public health system using the data available in a primary care setting.
A retrospective, population-based case-control study identified through autopsy reports subjects who died from suicide between 2010 and 2015 in Barcelona province. Those who had previous interaction with primary healthcare services were selected, and 20 controls per case with similar age, sex and residence area were randomly sampled from a primary healthcare medical database; the available medical data derived from routine primary care records were anonymised and retrieved for analysis in all subjects.
Of 2109 people deceased by suicide, 971 had previous primary healthcare interactions; 33.8% aged over 65 and 74% men. Of those with previous contact, 33% died during the week after and 58.5% within one month. A multivariable analysis identified several significant risk factors in the database, including previous suicide attempts, psychiatric diagnosis, number of primary healthcare visits, referrals to mental health, number of drugs prescribed, recent psychoactive drug prescriptions, and being on sick leave due to mental conditions in the previous year.
Nearly half of suicide subjects contacted primary healthcare before dying but remained either undetected or not effectively managed for prevention. In cases who interacted, available data on risk factors included high frequentation and being on sick leave due to mental health disorders, in addition to other well-known factors. Routine electronic medical records represent an opportunity to provide clinical-decision support tools that could be implemented through automatized risk calculation.HIGHLIGHTSMost of suicide patients had a recent interaction with the healthcare systemWell known risk factors were available in the routine electronic medical recordsAdditional alerting tools could be implemented through automatized risk calculation.
利用初级保健环境中可用的数据，描述与公共卫生系统有过接触后自杀身亡的人群特征。
通过尸检报告，回顾性地在巴塞罗那省确定了 2010 年至 2015 年期间死于自杀的人群。选择那些与初级卫生保健服务有过接触的人群，然后从初级卫生保健医疗数据库中按年龄、性别和居住地区与每个病例匹配 20 名对照；从所有研究对象的常规初级保健记录中提取和匿名可用的医疗数据进行分析。
在 2109 例自杀死亡者中，有 971 例有过初级卫生保健接触史；33.8%的人年龄超过 65 岁，74%为男性。在有过接触的人群中，33%在接触后的一周内死亡，58.5%在一个月内死亡。多变量分析在数据库中确定了几个显著的风险因素，包括既往自杀企图、精神科诊断、初级保健就诊次数、转介至精神卫生机构、开处的药物种类、近期精神活性药物处方以及前一年因精神健康状况请病假。
近一半的自杀者在死亡前曾与初级保健系统联系，但仍未被发现或未得到有效预防管理。在有接触的病例中，可获得的风险因素数据包括高就诊频率和因心理健康障碍请病假，除此之外还有其他已知的风险因素。常规电子病历提供了一个机会，可以提供临床决策支持工具，通过自动化风险计算来实施。
大多数自杀患者在近期与医疗系统有过接触。
常规电子病历中可获得已知的风险因素。
可以通过自动化风险计算实施额外的警示工具。
