POTENTIAL FOR SUICIDE-PREVENTION IN PRIMARY-CARE - AN ANALYSIS OF FACTORS ASSOCIATED WITH SUICIDE

Background. General practitioners (GPs) need to be aware of the risk f actors for suicide. GP records may provide clues to identifying the re lative importance of such risk factors. Aims. To identify, in suicide cases and matched controls, the patterns of consultation, diagnosis, a nd treatment of mental illness, and recording of risk factors for suic ide. To examine the usefulness of data routinely collected by GPs in c omputerized databases to investigate treatment of patients in general practice prior to suicide. Method. Case control study using GP records from the General Practice Research Database (GPRD). Three controls se lected for each case, matched for age, sex, and duration of registrati on with practice. Information extracted of the prevalence of major dis ease; diagnosis of, and treatment, or referral for, mental illness; fr equency of recording of recent life events; and consultations with the GP in the 12 months prior to death. Result. Of the 339 suicide cases recorded, 80% were male, which is similar to the national percentage f or this age group. Females were more likely than males to have a histo ry of mental illness and to have been diagnosed and treated for mental illness in the 12 months before death (59% versus 35%), and women wer e more likely to have previously attempted suicide (47% versus 27%). T here was no significant difference between males and females in period of time since last contact with GP practice, but females consulted mo re frequently. Twenty-nine per cent of cases had not consulted their G P in the six months prior to death. In multivariate analysis, the foll owing were identified as independent risk factors: history of attempte d suicide; untreated serious mental illness (odds ratios >20); recent (past 12 months) marital life event; alcohol abuse; frequent consultat ions with GP; and previous mental illness. Recording of life events by GPs was poor. Conclusions. Females at risk of suicide are more likely than males to have been diagnosed and treated for mental illness. It is likely that GPs are under-diagnosing and under-treating males at ri sk. Data from the GPRD give comparable results to those from other stu dies. The GPRD is a potentially useful tool for research into relative ly uncommon events in general practice.