Department of Clinical Sciences, Psychiatry, Lund University, Lund, SE-221 84, Sweden.
Office of Psychiatry and Habilitation, Region Skåne, Lund, SE-221 85, Sweden.
BMC Prim Care. 2024 Jul 15;25(1):256. doi: 10.1186/s12875-024-02498-y.
Individuals who die by suicide often consult their general practitioners (GPs) in their final weeks of life. The aim of this study was to gain a deeper knowledge of the clinical characteristics and GP assessments and treatments among individuals who consulted their GPs during the month preceding suicide. Further, we compared these features in those with and without contact with psychiatric services (PC and NPC, respectively) during the two years that preceded the suicide.
A nationwide retrospective explorative study investigating medical records.
Primary care in Sweden.
Individuals who died by suicide in Sweden in 2015 with a GP visit within 30 days of death.
The study cohort corresponds to one fifth (n = 238) of all suicides that occurred in Sweden in 2015 (n = 1179), representing all those with available primary care records showing contact with a GP during the final 30 days of life (NPC: n = 125; PC: n = 113). The mean age was 58 years ± 19. Patients in the NPC group were older (NPC: 63 years ± 19 vs. PC: 53 years ± 18, p < 0.0001) and presented psychiatric symptoms less often (NPC: 50% vs. PC: 67%, p < 0.006). Somatic symptoms were as common as psychiatric symptoms for the whole sample, being present in more than half of individuals. Suicide risk was noted in only 6% of all individuals. Referral to psychiatric services occurred in 14%, less commonly for the NPC group (NPC: 6% vs. PC: 22%, p < 0.001). Cardiovascular or respiratory symptoms were noted in 19%, more often in the NPC group (NPC: 30% vs. PC: 6%, p < 0.001), as were diagnoses involving the circulatory system (all 10%, NPC:14% vs. PC: 5%, p < 0.020).
A high level of somatic symptoms was observed in primary care patients both with and without psychiatric contact, and this might have influenced GPs' management decisions. Psychiatric symptoms were noted in two thirds of those with psychiatric contact but only half of those without. While GPs noted psychiatric symptoms in over half of all individuals included in the study, they seldom noted suicide risk. These findings highlight the need for increased attention to psychiatric symptoms and suicide risk assessment, particularly among middle-aged and older individuals presenting with somatic symptoms.
The National Cause of Death Register has excellent coverage of suicide deaths and access to medical records was very good. The medical record review provided detailed information regarding primary care utilization before death by suicide. Because of the lack of statistical power, due to the limited number of persons with GP contact during the last month of life, we chose not to correct for multiple comparisons. Our study approach did not capture the reasons behind GPs' documentation of elevated suicide risk. No systematic inter-rater reliability (IRR) testing was made, however, reviewers received training and continuous support from the research group.
自杀身亡的个体通常在生命的最后几周向全科医生（GP）咨询。本研究旨在深入了解在自杀前一个月内咨询全科医生的个体的临床特征和 GP 评估及治疗情况。此外，我们比较了这些特征在自杀前两年内分别与精神科服务（PC 和 NPC）有接触和无接触的个体之间的差异。
一项全国范围的回顾性探索性研究，调查医疗记录。
瑞典初级保健。
2015 年在瑞典自杀且在死亡前 30 天内有 GP 就诊的个体。
研究队列相当于瑞典 2015 年所有自杀事件的五分之一（n=1179）（n=238），代表所有在生命的最后 30 天内有接触全科医生记录的个体（NPC：n=125；PC：n=113）。平均年龄为 58 岁±19 岁。NPC 组患者年龄较大（NPC：63 岁±19 岁 vs. PC：53 岁±18 岁，p<0.0001），出现精神症状的频率较低（NPC：50% vs. PC：67%，p<0.006）。躯体症状与精神症状一样常见，超过一半的个体存在躯体症状。仅在 6%的个体中注意到自杀风险。向精神科服务机构转诊的比例为 14%，NPC 组较少（NPC：6% vs. PC：22%，p<0.001）。心血管或呼吸系统症状占 19%，在 NPC 组更为常见（NPC：30% vs. PC：6%，p<0.001），循环系统相关诊断也更为常见（均为 10%，NPC：14% vs. PC：5%，p<0.020）。
在有和没有精神科接触的初级保健患者中均观察到高水平的躯体症状，这可能影响了 GP 的管理决策。有精神科接触的个体中有三分之二注意到精神症状，但没有精神科接触的个体中只有一半注意到。虽然 GP 在研究中纳入的所有个体中有一半以上注意到精神症状，但他们很少注意到自杀风险。这些发现强调需要更加关注精神症状和自杀风险评估，特别是在出现躯体症状的中年和老年个体中。
国家死因登记处对自杀死亡的覆盖范围很好，并且可以很好地获取医疗记录。医疗记录审查提供了自杀前最后一个月内初级保健利用情况的详细信息。由于统计能力有限，由于生命最后一个月有 GP 接触的个体数量有限，我们选择不进行多次比较校正。我们的研究方法没有捕捉到 GP 记录自杀风险增加的原因。由于没有进行系统的一致性检验（IRR），但是，审查员接受了研究小组的培训和持续支持。
