Abstract
BackgroundSuicide accounts for more than 800,000 annual deaths worldwide. Some of these deaths may be preventable by timely identification of individuals at risk and effective intervention. General practitioners (GPs) may have the potential to play an important role in this process.AimThe present study aimed to assess the frequency of primary health care utilization in the year preceding suicide.MethodsUsing Danish national registers, we identified all persons who died by suicide in Denmark from 1997 through 2013 and assessed the frequency of their primary care utilization and compared it with that of an age- and sex-matched reference group sampled from the background population.ResultsWe identified 11,191 persons who died by suicide (males: 8,095, females: 3,096). Compared with the reference group (N = 55,955), a greater proportion attended general practice in the year before index date (83% vs. 76%). In the last month before index date, these figures were 32.0% and 19.4%, respectively, corresponding to a difference of 12.0 95% CI: (11.1; 12.9) percentage points after adjustment for demographic characteristics and physical comorbidity. Suicide cases had a higher GP attendance in every week in the year before suicide, but the difference increased specifically in the last four months.ConclusionMore than 30% attended the GP in the month before the suicide. This indicates that general practice could be a possible place to identify suicide cases and offer intervention. However, although this proportion represents a markedly higher GP attendance than seen in the reference group, almost 70% of those who died by suicide did not attend primary care in the month before the suicide. Our study suggests that it is important that the GPs have easy access to effective suicide prevention programs for patients at risk of suicide, and that persons with suicidal thoughts are encouraged to contact their GP.
Highlights
More than 800,000 persons die by suicide every year [1]
Using Danish national registers, we identified all persons who died by suicide in Denmark from 1997 through 2013 and assessed the frequency of their primary care utilization and compared it with that of an age- and sex-matched reference group sampled from the background population
We identified 11,191 persons who died by suicide
Summary
More than 800,000 persons die by suicide every year [1]. Mounting evidence suggests that some suicides could be prevented if persons at risk are identified and offered specialized treatment [2,3,4].About 98% of the population in Denmark is listed with a specific general practice and receives publicly funded health care services free of charge [5]. Previous studies have been limited by small sample sizes [8,9,10,11,12,14], lack of reference group [6,7,9,10,11,12], potentially incomplete data [7], and restrictions to selected groups [8,10] All these limitations challenge the generalizability of findings, including assessment of the extent to which the GP utilization among persons who die by suicide differ from that of persons with similar characteristics who do not die by suicide. Editor: Vincenzo De Luca, University of Toronto, CANADA Received: November 29, 2018 Accepted: March 17, 2019
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