GPs’ views and perspectives on patient non-adherence to treatment in primary care prior to suicide

Abstract

Background: Individuals who do not adhere to their treatment regimens may be at greater risk of suicide but these issues are relatively unexplored in primary care services.

Aim: To explore GPs’ views and perspectives on the reasons why patients who were in contact with mental health services in the year prior to suicide was non-adherent to treatment prior to their death.

Method: In total, 198 semi-structured face-to-face interviews with GPs of people who had died by suicide. Interviews were transcribed verbatim and analyzed using a thematic approach.

Results: The following themes were conceptualized from GP interviews: (i) “Lack of insight or denial?” relates to what GPs perceived as their patients lack of insight into their psychiatric illness; (ii) “Lack of treatment choices” discusses GPs’ understanding of patient treatment choices; (iii) “Services for comorbidity and dual diagnosis” refers to treatment availability for suicidal patients with two or more mental health diagnoses.

Conclusions: For suicide prevention, it is crucial for health professionals to assess patients and manage the possible causes of non-adherence. Policies for increasing treatment adherence, improving services for dual diagnosis, or providing alternative treatments to meet individual patient needs may help to achieve the best health outcomes and could potentially prevent suicide.

Keywords:

• Suicide
• non-adherence
• primary care
• secondary care
• mental health

Acknowledgements

We thank all participating GPs and the PCTs that allowed us access to medical records and participated in interviews. The study was carried out as part of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. We thank the other members of the research team: David While, Kirsten Windfuhr, Alyson Williams, Anna Pearson, Damien Da Cruz, Caroline Miles, Harriet Bickley, Jimmy Burns, Isabelle Hunt, Rebecca Lowe, Phil Stones, Pauline Turnbull, Sandra Flynn, Cathy Rodway, Alison Roscoe, and Kelly Hadfield. We acknowledge the help of Professor Louis Appleby, Professor Jenny Shaw, health authorities, trust contacts, and consultant psychiatrists for completing the questionnaires.

Declaration of interest

NK was Chair of the Guideline Development Group for the National Institute for Clinical Excellence (NICE) guidelines for the longer term management of self-harm, currently chairs the depression in adults’ guideline, and sits on the Department of Health’s National Suicide Prevention Strategy Advisory Group.

This study was initiated while NCISH was funded by the National Patient Safety Agency and funding was transferred to the Healthcare Quality Improvement Partnership in 2011.

Competing Interests

The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health

Ethics

Ethical approval was granted by the North-west Research Ethics Committee (REC reference: 02/8/74) for the Inquiry as a whole. Individual R&D approvals were also obtained from all the relevant Mental Health Trusts included in the study.