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.

中文翻译：

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自杀前精神科服务的使用——对有和没有自杀企图的使用者的回顾性比较

摘要

介绍

目的是调查有自杀未遂 (PSA) 与无自杀未遂 (NSA) 的个体在自杀死亡前两年对精神卫生保健的利用情况。

方法

开展了一项基于人群的回顾性队列研究，纳入了 484 名 2015 年在瑞典死于自杀并在死前两年内接受过精神病治疗的人，这些人是通过死因登记册确定的。使用了死亡前两年的精神卫生保健数据，包括根据医疗记录中的注释自杀未遂。具有至少一种 PSA与NSA 和医疗保健利用之间的关联通过逻辑回归分析估计为优势比 (OR) 和 95% 置信区间 (CI)。

结果

在纳入的 484 人中，51% 的人患有 PSA。与 NSA 相比，PSA 患者更有可能接受精神病诊断 [OR 1.96 (CI 95% 1.17–3.30)]、持续接受精神药物治疗 [OR 1.96 (CI 95% 1.15–3.36)] 并且未参加最近三个月的约会 [1.97 (1.25–3.13)]。此外，与没有 PSA 的患者相比，PSA 患者的精神病病例记录中自杀风险升高的频率更高 [OR 2.17 (CI 95% 1.24–3.79)]。

结论

结果强调了改进自杀风险评估以及全面诊断评估的重要性，以及在需要时将精神治疗作为自杀预防干预措施的重要性，而与 PSA 无关。此外，PSA 患者中较大比例的缺席可能表明需要改善精神科护理提供者与 PSA 患者之间的联盟。

• 强调

• 在有过自杀未遂 (PSA) 的人群中，被评估为自杀风险升高的情况更为常见。

• 五分之一之前没有尝试过（NSA）的人没有精神病学诊断，而在有 PSA 的人中，这一比例为十分之一。

• 接受精神药物治疗在 PSA 患者中更为常见。