Sellin Tabita, Waern Margda, Bergqvist Erik, Palmqvist Öberg Nina, Lindström Sara, Fröding Elin, Ehnvall Anna, Westrin Åsa
Faculty of Medicine and Health, University Health Care Research Center, Örebro University Hospital, Örebro University, Orebro, Sweden
Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg. Psychosis Department, Sahlgrenska University Hospital, Region Västra Götaland, SE-431 30 Mölndal, Göteborg, Sweden.
BMJ Open. 2025 May 15;15(5):e086633. doi: 10.1136/bmjopen-2024-086633.
To evaluate whether suicidality was documented prior to suicide in patients in contact with specialised somatic healthcare providers for physical conditions and to identify factors related to such documentation.
Retrospective cohort study in which medical records from specialised somatic (non-psychiatric) healthcare services (internal medicine, infectious disease, surgery, urology, etc) in 20 of Sweden's 21 regions were reviewed up to 2 years before suicide.
Those who died by suicide in Sweden 2015 and had received specialised somatic healthcare for a diagnosed physical condition were included, n=468 (331 men and 137 women). THE OUTCOME VARIABLE: (ie, death wishes, suicidal thoughts, plans, attempts and notations of known suicidality or elevated suicide risk). Potential associations of patients' characteristics and clinical factors with the outcome were tested in logistic regression models.
Of the 468 patients, 111 (24%) were positive for the outcome variable regardless of whether they were assessed as suicidal or not. Elevated suicide risk was noted in 27 patients (6% of the total cohort). Multivariate logistic regression analysis showed that experience of distress (OR: 4.81; 95% CI: 1.96 to 11.81), contact with psychiatric services (OR: 4.68; 95% CI: 2.60 to 8.43), psychiatric comorbidity (OR: 4.33; 95% CI: 2.41 to 7.76) and female sex (OR: 2.91; 95% CI: 1.68 to 5.06) were independently associated with documentation of suicidality. A third (36%) had a doctor consultation in specialised somatic healthcare during their last month of life. Of these, 17% were assessed for suicidality, and elevated suicide risk was noted in 7%.
Documentation of suicidality was observed in one quarter of patients who received specialised somatic healthcare for physical conditions and subsequently died by suicide. These results indicate a need to increase clinician awareness of suicidal issues and assessments and to integrate questions about mental health into specialised somatic practice.
评估在因身体状况与专科躯体医疗服务提供者接触的患者中，自杀行为在自杀前是否有记录，并确定与这种记录相关的因素。
回顾性队列研究，对瑞典21个地区中20个地区的专科躯体（非精神科）医疗服务（内科、传染病科、外科、泌尿科等）的病历进行审查，时间跨度至自杀前2年。
纳入2015年在瑞典自杀且因确诊的身体状况接受过专科躯体医疗服务的患者，共468例（男性331例，女性137例）。结局变量：（即死亡意愿、自杀念头、计划、企图以及已知自杀行为或自杀风险升高的记录）。在逻辑回归模型中测试患者特征和临床因素与结局的潜在关联。
在468例患者中，111例（24%）结局变量呈阳性，无论他们是否被评估为有自杀倾向。27例患者（占总队列的6%）被记录有自杀风险升高。多因素逻辑回归分析显示，痛苦经历（比值比：4.81；95%置信区间：1.96至11.81）、与精神科服务接触（比值比：4.68；95%置信区间：2.60至8.43）、精神科合并症（比值比：4.33；95%置信区间：2.41至7.76）和女性（比值比：2.91；95%置信区间：1.68至5.06）与自杀行为记录独立相关。三分之一（36%）的患者在生命的最后一个月接受了专科躯体医疗服务的医生会诊。其中，17%接受了自杀倾向评估，7%被记录有自杀风险升高。
在因身体状况接受专科躯体医疗服务且随后自杀死亡的患者中，四分之一有自杀行为记录。这些结果表明需要提高临床医生对自杀问题和评估的认识，并将心理健康问题纳入专科躯体医疗实践中。
