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Contacts with primary and secondary healthcare before suicide by those under the care of mental health services: case–control, whole-population-based study using person-level linked routine data in Wales, UK during 2000–2015

Marcos del Pozo Banos Orcid Logo, Cathryn Rodway Orcid Logo, Sze Chim Lee, Olivier Rouquette Orcid Logo, Saied Ibrahim, Keith Lloyd Orcid Logo, Louis Appleby, Navneet Kapur Orcid Logo, Ann John Orcid Logo

BJPsych Open, Volume: 10, Issue: 3

Swansea University Authors: Marcos del Pozo Banos Orcid Logo, Sze Chim Lee, Olivier Rouquette Orcid Logo, Keith Lloyd Orcid Logo, Ann John Orcid Logo

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DOI (Published version): 10.1192/bjo.2024.23

Abstract

BackgroundPeople under mental health (MH) services’ care are at increased risk of suicide. Existing studies are small in scale and lack comparisons.AimTo identify opportunities for suicide prevention and underpinning data enhancement in people with recent contact with MH services.MethodPopulation-ba...

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Published in: BJPsych Open
ISSN: 2056-4724
Published: Royal College of Psychiatrists 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa65583
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Abstract: BackgroundPeople under mental health (MH) services’ care are at increased risk of suicide. Existing studies are small in scale and lack comparisons.AimTo identify opportunities for suicide prevention and underpinning data enhancement in people with recent contact with MH services.MethodPopulation-based study of all who died by suicide in the year following a MH services contact in Wales, 2001–2015 (cases), paired with similar patients who did not die by suicide (controls). We linked the National Confidential Inquiry into Suicide and Safety in Mental Health and the Suicide Information Database - Cymru with primary and secondary healthcare records. We present odds ratios and 95% confidence intervals (OR [95% CI]) of conditional logistic regression.ResultsWe matched 1,031 cases with 5,155 controls. In the year before their death, 98.3% of cases were in contact with healthcare services, and 28.5% presented with self-harm. Cases had more emergency department contacts (OR=2.4 [2.1-2.7]) and emergency hospital admissions (OR=1.5 [1.4-1.7]), but less primary care contacts (OR=0.7 [0.6-0.9]) and outpatient appointments (OR=0.2 [0.2-0.3]) than controls. ORs were larger in females than males for injury and poisoning (OR=3.3 [2.5-4.5] vs 2.6 [2.1-3.1]).ConclusionWe may be missing existing opportunities to intervene, particularly in emergency departments and hospital admissions with self-harm presentations, and with unattributed self-harm, especially in females. Prevention efforts should focus on strengthening routine care contacts, responding to emergency contacts, and better self-harm care. There are benefits to enhancing clinical audit systems with routinely collected data for data completeness, breadth, and depth
Keywords: Suicide; electronic health records; primary care; secondary care; mental health services
College: Faculty of Medicine, Health and Life Sciences
Funders: AJ and MDPB, were funded by the Medical Research Council and Health Data Research UK (Grant DATAMIND: Data Hub for Mental Health INformatics research Development, with Ref.: MR/W014386/1), AJ, KL, OR and SCL through Health and Care Research Wales (grant awarded to ‘The National Centre for Mental Health’ Grant No.: CA04), and SID-Cymru (Grant Ref.:12-25). CR, SI, LA and NK were funded by Healthcare Quality Improvement Partnership
Issue: 3