CASE-CONTROL STUDY OF GP ATTENDANCE RATES BY SUICIDE CASES WITH OR WITHOUT A PSYCHIATRIC HISTORY

Background. Targets for reduction in suicide deaths have been set agai nst a background of an increasing number of people committing suicide. It is often assumed that a reduction can be effected by increasing th e detection in primary care of patients at risk. This presupposes that there are indicators that enable suicide risk to be detected reliably . Aim. To compare the characteristics of those who commit suicide with an age- and sex-matched control group in terms of level of general pr actitioner attendance, diagnosis and pharmacological treatment of ment al illness, and to compare those suicides with and without a psychiatr ic history in terms of general practitioner attendance and history of pharmacological treatment. Method. From a total of 48 deaths attribute d to suicide and undetermined causes in the Forth Valley in 1993, gene ral practice case notes were located for 41. Live controls were matche d to index cases by age, sex and practice. Information on consultation s, referrals to secondary care, medication and diagnoses in the previo us 10 years was extracted from general practice and, for suicides, psy chiatric case notes. Results. Over the 10-year period, suicide patient s attended their general practitioner at a higher level than control s ubjects. However, the number of suicide patients who attend ed their g eneral practitioner in the month before their death did not differ in comparison with control subjects over a similar period. Suicide cases, in comparison with control subjects, were more likely to have receive d a psychiatric diagnosis from their general practitioner, been prescr ibed psychotropic medication and received referral to specialist menta l health services. Those suicide patients with a psychiatric history h ad a significantly higher number of general practitioner consultations than those without a psychiatric history in four out of the five year s preceding death. Those suicide patients without a psychiatric histor y did not differ significantly from control subjects on any of the var iables assessed. Conclusion. For those people committing suicide who d o nor have a psychiatric history and whose consultation patterns do no t differ from the norm, it is difficult to suggest how general practit ioners might improve their detection of relevant suicidal risk factors . For those patients with a psychiatric history who commit suicide, un til we have more detailed information regarding the specific content o f general practitioner's consultations before death and how these diff ered from other consultations of the deceased, then it is premature to assume that general practitioners are failing to identify indicators of impending suicide.