Abstract

Objectives

To characterize people who died by suicide after having previous contacts with public health system using the data available in a primary care setting.

Method

A retrospective, population-based case-control study identified through autopsy reports subjects who died from suicide between 2010 and 2015 in Barcelona province. Those who had previous interaction with primary healthcare services were selected, and 20 controls per case with similar age, sex and residence area were randomly sampled from a primary healthcare medical database; the available medical data derived from routine primary care records were anonymised and retrieved for analysis in all subjects.

Results

Of 2109 people deceased by suicide, 971 had previous primary healthcare interactions; 33.8% aged over 65 and 74% men. Of those with previous contact, 33% died during the week after and 58.5% within one month. A multivariable analysis identified several significant risk factors in the database, including previous suicide attempts, psychiatric diagnosis, number of primary healthcare visits, referrals to mental health, number of drugs prescribed, recent psychoactive drug prescriptions, and being on sick leave due to mental conditions in the previous year.

Conclusions

Nearly half of suicide subjects contacted primary healthcare before dying but remained either undetected or not effectively managed for prevention. In cases who interacted, available data on risk factors included high frequentation and being on sick leave due to mental health disorders, in addition to other well-known factors. Routine electronic medical records represent an opportunity to provide clinical-decision support tools that could be implemented through automatized risk calculation.

• HIGHLIGHTS

• Most of suicide patients had a recent interaction with the healthcare system

• Well known risk factors were available in the routine electronic medical records

• Additional alerting tools could be implemented through automatized risk calculation

中文翻译：

---

常规初级保健记录可以帮助检测自杀风险吗？巴塞罗那基于人群的病例对照研究

摘要

目标

使用初级保健机构中可用的数据来描述在与公共卫生系统有过接触后自杀身亡的人。

方法

一项通过尸检确定的回顾性、基于人群的病例对照研究报告了 2010 年至 2015 年间在巴塞罗那省死于自杀的受试者。选择以前与基层医疗服务有过互动的人，从基层医疗数据库中随机抽取20名年龄、性别、居住地区相近的对照组；从常规初级保健记录中获得的可用医疗数据被匿名化并检索以对所有受试者进行分析。

结果

在自杀身亡的 2109 人中，有 971 人之前曾接触过初级保健；33.8% 年龄在 65 岁以上，74% 为男性。在之前接触过的人中，33% 的人在一周后死亡，58.5% 的人在一个月内死亡。一项多变量分析确定了数据库中的几个重要风险因素，包括以前的自杀未遂、精神病诊断、初级保健就诊次数、心理健康转诊、处方药数量、最近的精神药物处方以及因精神状况而休病假在上一年。

结论

近一半的自杀者在死前联系了初级保健机构，但要么未被发现，要么没有得到有效的预防管理。在互动的案例中，除了其他众所周知的因素外，有关风险因素的可用数据还包括高频率和因精神健康障碍而请病假。常规电子病历代表了提供临床决策支持工具的机会，这些工具可以通过自动化风险计算来实施。

• 强调

• 大多数自杀患者最近与医疗保健系统有过互动

• 常规电子病历中有众所周知的风险因素

• 可以通过自动化风险计算来实施额外的警报工具