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

Figures & data

TABLE 1. Characteristics of individuals in contact with psychiatric services who died by suicide (n = 484), crude and adjusted odds ratio (OR) with 95% confidence interval (95% CI) for the association between gender, age, type of diagnosis, and having at least one known previous attempt/s (PSA) vs. without previous attempt/s (NSA).

	Total cohort	PSA n = 246	NSA n = 238	Crude	Adjusted*
	% (column) (n)	% (column) (n)	% (column) (n)	OR (95% CI)	OR (95% CI)
Gender
Men	65 (316)	57 (139)	74 (177)	1	1
Women	35 (168)	43 (107)	26 (61)	2.23 (1.52–3.28)	2.38 (1.59–3.55)
Age** (years)
≤19	4 (20)	2 (5)	6 (15)	0.27 (0.08–0.86)	0.24 (0.07–0.79)
20–29	15 (73)	18 (45)	12 (28)	1.30 (0.62–2.73)	1.52 (0.71–3.28)
30–39	15 (75)	19 (46)	12 (29)	1.28 (0.61–2.68)	1.40 (0.66–2.99)
40–49	18 (88)	17 (42)	19 (46)	0.74 (0.36–1.50)	0.89 (0.43–1.85)
50–59	53 (110)	22 (53)	24 (57)	0.75 (0.38–1.49)	0.87 (0.43–1.76)
60–69	15 (71)	12 (29)	18 (42)	0.56 (0.27–1.17)	0.62 (0.29–1.33)
≥70	10 (47)	11 (26)	9 (21)	1	1
Psychiatric diagnosis***
No diagnosis	17 (80)	11 (28)	22 (52)	1
Any psychiatric diagnosis	83 (404)	89 (218)	78 (186)	2.18 (1.32–3.59)	1.96 (1.17–3.30)
Any psychiatric comorbidity	82 (395)	87 (214)	76 (181)	2.11 (1.31–3.39)	1.94 (1.18–3.20)
Mood disorder	39 (188)	44 (109)	33 (79)	1.60 (1.11–2.32)	1.64 (1.11–2.41)
Bipolar affective disorder	10 (49)	15 (36)	5 (13)	2.97 (1.53–5.75)	2.99 (1.50–5.96)
Personality Disorder	8 (39)	13 (33)	3 (6)	5.99 (2.46–14.58)	5.14 (2.06–12.82)
Schizophrenia	3 (16)	2 (4)	5 (12)	0.31 (0.10–0.98)	0.38 (0.12–1.21)

Bold marks statistically significant results.

*Gender only adjusted for age, age only adjusted for gender. Psychiatric diagnoses adjusted for both age and gender.

**At the time of death.

***Last noted before suicide. Only diagnoses with statistically significant differences (in the crude model) between individuals with PA and NA are presented.

TABLE 2. Individuals in contact with psychiatric services who died by suicide (n = 484), crude and adjusted odds ratio (OR) with 95% confidence interval (95% CI) for the association between length and proximity of psychiatric contact, absence from appointment, and having at least one known previous attempt/s (PSA) vs. without previous attempt/s (NSA).

	PSA n = 246	NSA n = 238	Crude	Adjusted for age and gender	Adjusted for gender, age, and comorbidity
	% (n)	% (n)	OR (95% CI)	OR (95% CI)	OR (95% CI)
Length of contact* (days)
0–89	37 (33)	63 (57)	0.41 (0.24–0.72)	0.43 (0.24–0.77)	0.47 (0.26–0.84)
90–365	64 (55)	36 (31)	1.26 (0.72–2.21)	1.51 (0.83–2.75)	1.58 (0.86–2.90)
366–729	48 (37)	52 (40)	0.66 (0.37–1.16)	0.73 (0.40–1.33)	0.80 (0.43–1.47)
≥730	59 (76)	42 (54)	1	1	1
Proximity of contact** (days)
0–7	56 (101)	44 (78)	1	1	1
8–28	52 (62)	48 (57)	0.84 (0.53–1.34)	0.85 (0.52–1.38)	0.89 (0.55–1.45)
29–90	52 (45)	48 (42)	0.83 (0.50–1.38)	0.88 (0.52–1.51)	0.92 (0.54–1.57)
90–365	46 (28)	54 (33)	0.66 (0.37–1.18)	0.68 (0.37–1.25)	0.79 (0.42–1.49)
≥366	26 (10)	72 (28)	0.28 (0.13–0.60)	0.27 (0.12–0.61)	0.33 (0.14–0.77)
Absent from appointment***	64 (70)	36 (39)	2.00 (1.29–3.12)	1.98 (1.24–3.17)	1.97 (1.25–3.13)

Bold marks statistically significant results.

*Number of days from first registered contact with psychiatry.

**Number of days from last psychiatric contact to suicide.

***During the last 3 months.

FIGURE 1. Proportions (%) with ongoing and planned psychiatric interventions and suicide risk assessment among patients who died by suicide, by suicide attempt history (n = 238).

TABLE 3. Crude and adjusted odds ratio (OR) with 95% confidence interval (95% CI) for associations between the ongoing and planned psychiatric interventions, suicide risk assessment, and having at least one known previous attempt/s (PSA) vs. without previous attempt/s (NSA).

	Crude	Adjusted for age and gender	Adjusted for gender, age, and comorbidity
	OR (95% CI)	OR (95% CI)	OR (95% CI)
Ongoing interventions
Psycho-pharmacological	2.45 (1.50–4.02)	2.20 (1.30–3.72)	1.96 (1.15–3.36)
Psychotherapy/counseling	1.55 (1.06–2.25)	1.31 (0.88–1.96)	1.20 (0.80–1.80)
Planned interventions*
Agreement on treatment	1.64 (1.11–2.42)	1.63 (1.08–2.45)	1.48 (0.97–2.25)
Contact with community psychiatry for joint planning	1.94 (1.14–3.31)	1.95 (1.12–3.42)	1.89 (1.07–3.32)
Suicide risk assessment
Suicide risk elevated at last visit to psychiatrist	2.33 (1.37–3.96)	2.23 (1.28–3.88)	2.17 (1.24–3.79)
Suicide risk assessed within 4 weeks before death	1.58 (1.10–2.26)	1.49 (1.03–2.17)	1.33 (0.90–1.96)

Bold marks statistically significant results.

*Planned at the last visit to psychiatrist.

DATA AVAILABILITY STATEMENT

Data are available upon reasonable request.