Utilization of psychiatric services prior to suicide- a retrospective comparison of users with and without previous suicide attempts

Abstract

Introduction

The aim was to investigate psychiatric health care utilization two years before death by suicide among individuals with previous suicide attempts (PSA) compared with those without (NSA).

Method

A retrospective population-based cohort study was conducted including 484 individuals who died by suicide in Sweden in 2015 and were in contact with psychiatric services within the two years preceding death, identified through the Cause of Death register. Data on psychiatric health care two years before death, including suicide attempts according to notes in the medical record was used. Associations between having at least one PSA vs. NSA and health care utilization were estimated as odds ratios (OR) with 95% confidence intervals (CI) by logistic regression analyses.

Results

Of the 484 individuals included, 51% had PSA. Those with PSA were more likely than NSA to have received a psychiatric diagnosis [OR 1.96 (CI 95% 1.17–3.30)], to have ongoing psychotropic medication [OR 1.96 (CI 95% 1.15–3.36)] and to have been absent from appointments during the last three months [1.97 (1.25–3.13)]. In addition, elevated suicide risk was more often noted in the psychiatric case records of those with a PSA than those without [OR 2.17 (CI 95% 1.24–3.79)].

Conclusion

The results underline the importance of improved suicide risk assessment as well as thorough diagnostic assessment and when indicated, psychiatric treatment as suicide preventive interventions regardless of PSA. Furthermore, the larger proportion of absence from appointments in individuals with PSA may indicate a need of improved alliance between psychiatric care providers and individuals with PSA.

HIGHLIGHTS

• Being assessed with elevated suicide risk was more common among those with previous attempt/s (PSA).

• One-fifth of all with no previous attempt (NSA) had no psychiatric diagnosis, compared to one in ten in those with PSA.

• Receiving psychotropic medication was more common among those with PSA.

Keywords:

• Medical records
• psychiatric health care utilization
• suicide
• suicide attempts

ACKNOWLEDGMENTS

The authors are grateful to all regional representatives of Sweden and investigators who participated in data collection, to the Swedish suicide prevention network and health care management network in Sweden who encouraged all regions to join the study, and to Catharina Nygren, research administrator, Region Skåne, who aided in the implementation of this study.

DISCLOSURE STATEMENT

The authors declare no conflict of interest.

AUTHOR NOTES

ÅW is the principal investigator, initiated and designed the study, and acquired the data. ÅW, EF, AE, and NPÖ developed the protocol that was used to extract medical record data. SPL, EF, EB, NPÖ, and TS collected data, and SPL, EB, and NPÖ trained other investigators to collect data. SPL and MV designed the statistical strategy. SPL, MV, EF, MW, and ÅW contributed to the presentation of data in the tables. ÅW, SPL, MV, MW, EF, LA, AE, and TS contributed to designing the study and interpretation of the data. SPL drafted the manuscript and made the statistical analysis. ÅW, MW, MV, LA, AE, EF, TS, EB, and NPÖ revised the manuscript. All authors read and approved the final manuscript.

DATA AVAILABILITY STATEMENT

Data are available upon reasonable request.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Notes

1 Swedish law of public access to information and secrecy, SFS 2009:400 C.F.R.

Additional information

Funding

This work was supported by The Southern Health Care Region, Sweden, the National Board of Public Health and by state grants (ALF) from the province of Skåne, Sweden.

Notes on contributors

Sara Probert-Lindström

Sara Probert-Lindström, Livia Ambrus, MD, PhD, Erik Bergqvist, MD, Nina Palmqvist-Öberg, MD, and Åsa Westrin, MD, PhD, Lund University, Lund, Sweden.

Marjan Vaez

Marjan Vaez, Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.

Elin Fröding

Elin Fröding, MD, Jönköping University, Jönköping, Sweden.

Anna Ehnvall

Anna Ehnvall, MD, PhD, and Margda Waern, MD, PhD, University of Gothenburg, Gothenburg, Sweden.

Tabita Sellin

Tabita Sellin, PhD, University Health Care Research Center, Örebro University, Örebro, Sweden.

Livia Ambrus

Sara Probert-Lindström, Livia Ambrus, MD, PhD, Erik Bergqvist, MD, Nina Palmqvist-Öberg, MD, and Åsa Westrin, MD, PhD, Lund University, Lund, Sweden.

Erik Bergqvist

Sara Probert-Lindström, Livia Ambrus, MD, PhD, Erik Bergqvist, MD, Nina Palmqvist-Öberg, MD, and Åsa Westrin, MD, PhD, Lund University, Lund, Sweden.

Nina Palmqvist-Öberg

Sara Probert-Lindström, Livia Ambrus, MD, PhD, Erik Bergqvist, MD, Nina Palmqvist-Öberg, MD, and Åsa Westrin, MD, PhD, Lund University, Lund, Sweden.

Margda Waern

Anna Ehnvall, MD, PhD, and Margda Waern, MD, PhD, University of Gothenburg, Gothenburg, Sweden.

Åsa Westrin

Sara Probert-Lindström, Livia Ambrus, MD, PhD, Erik Bergqvist, MD, Nina Palmqvist-Öberg, MD, and Åsa Westrin, MD, PhD, Lund University, Lund, Sweden.