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Contacts with primary and secondary healthcare before suicide by those under the care of mental health services: case–control, whole-population-based study using person-level linked routine data in Wales, UK during 2000–2015

Marcos del Pozo Banos Orcid Logo, Cathryn Rodway Orcid Logo, Sze Chim Lee, Olivier Rouquette Orcid Logo, Saied Ibrahim, Keith Lloyd Orcid Logo, Louis Appleby, Navneet Kapur Orcid Logo, Ann John Orcid Logo

BJPsych Open, Volume: 10, Issue: 3

Swansea University Authors: Marcos del Pozo Banos Orcid Logo, Sze Chim Lee, Olivier Rouquette Orcid Logo, Keith Lloyd Orcid Logo, Ann John Orcid Logo

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DOI (Published version): 10.1192/bjo.2024.23

Abstract

BackgroundPeople under mental health (MH) services’ care are at increased risk of suicide. Existing studies are small in scale and lack comparisons.AimTo identify opportunities for suicide prevention and underpinning data enhancement in people with recent contact with MH services.MethodPopulation-ba...

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Published in: BJPsych Open
ISSN: 2056-4724
Published: Royal College of Psychiatrists 2024
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Existing studies are small in scale and lack comparisons.AimTo identify opportunities for suicide prevention and underpinning data enhancement in people with recent contact with MH services.MethodPopulation-based study of all who died by suicide in the year following a MH services contact in Wales, 2001–2015 (cases), paired with similar patients who did not die by suicide (controls). We linked the National Confidential Inquiry into Suicide and Safety in Mental Health and the Suicide Information Database - Cymru with primary and secondary healthcare records. We present odds ratios and 95% confidence intervals (OR [95% CI]) of conditional logistic regression.ResultsWe matched 1,031 cases with 5,155 controls. In the year before their death, 98.3% of cases were in contact with healthcare services, and 28.5% presented with self-harm. Cases had more emergency department contacts (OR=2.4 [2.1-2.7]) and emergency hospital admissions (OR=1.5 [1.4-1.7]), but less primary care contacts (OR=0.7 [0.6-0.9]) and outpatient appointments (OR=0.2 [0.2-0.3]) than controls. ORs were larger in females than males for injury and poisoning (OR=3.3 [2.5-4.5] vs 2.6 [2.1-3.1]).ConclusionWe may be missing existing opportunities to intervene, particularly in emergency departments and hospital admissions with self-harm presentations, and with unattributed self-harm, especially in females. Prevention efforts should focus on strengthening routine care contacts, responding to emergency contacts, and better self-harm care. 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spelling v2 65583 2024-02-07 Contacts with primary and secondary healthcare before suicide by those under the care of mental health services: case–control, whole-population-based study using person-level linked routine data in Wales, UK during 2000–2015 f141785b1c0ab9efe45665d35c081b84 0000-0003-1502-389X Marcos del Pozo Banos Marcos del Pozo Banos true false 10628af4988d624b49c4de7bd78b4694 Sze Chim Lee Sze Chim Lee true false 0e502db88ea48ce6b053ed0eef9a54ce 0000-0001-8088-4800 Olivier Rouquette Olivier Rouquette true false a13aaa0df9045c205e82ed3b95d18c10 0000-0002-1440-4124 Keith Lloyd Keith Lloyd true false ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 2024-02-07 MEDS BackgroundPeople under mental health (MH) services’ care are at increased risk of suicide. Existing studies are small in scale and lack comparisons.AimTo identify opportunities for suicide prevention and underpinning data enhancement in people with recent contact with MH services.MethodPopulation-based study of all who died by suicide in the year following a MH services contact in Wales, 2001–2015 (cases), paired with similar patients who did not die by suicide (controls). We linked the National Confidential Inquiry into Suicide and Safety in Mental Health and the Suicide Information Database - Cymru with primary and secondary healthcare records. We present odds ratios and 95% confidence intervals (OR [95% CI]) of conditional logistic regression.ResultsWe matched 1,031 cases with 5,155 controls. In the year before their death, 98.3% of cases were in contact with healthcare services, and 28.5% presented with self-harm. Cases had more emergency department contacts (OR=2.4 [2.1-2.7]) and emergency hospital admissions (OR=1.5 [1.4-1.7]), but less primary care contacts (OR=0.7 [0.6-0.9]) and outpatient appointments (OR=0.2 [0.2-0.3]) than controls. ORs were larger in females than males for injury and poisoning (OR=3.3 [2.5-4.5] vs 2.6 [2.1-3.1]).ConclusionWe may be missing existing opportunities to intervene, particularly in emergency departments and hospital admissions with self-harm presentations, and with unattributed self-harm, especially in females. Prevention efforts should focus on strengthening routine care contacts, responding to emergency contacts, and better self-harm care. There are benefits to enhancing clinical audit systems with routinely collected data for data completeness, breadth, and depth Journal Article BJPsych Open 10 3 Royal College of Psychiatrists 2056-4724 Suicide; electronic health records; primary care; secondary care; mental health services 10 5 2024 2024-05-10 10.1192/bjo.2024.23 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University SU Library paid the OA fee (TA Institutional Deal) AJ and MDPB, were funded by the Medical Research Council and Health Data Research UK (Grant DATAMIND: Data Hub for Mental Health INformatics research Development, with Ref.: MR/W014386/1), AJ, KL, OR and SCL through Health and Care Research Wales (grant awarded to ‘The National Centre for Mental Health’ Grant No.: CA04), and SID-Cymru (Grant Ref.:12-25). CR, SI, LA and NK were funded by Healthcare Quality Improvement Partnership 2024-05-31T13:02:17.8470293 2024-02-07T11:33:12.1354999 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Marcos del Pozo Banos 0000-0003-1502-389X 1 Cathryn Rodway 0000-0003-0007-0124 2 Sze Chim Lee 3 Olivier Rouquette 0000-0001-8088-4800 4 Saied Ibrahim 5 Keith Lloyd 0000-0002-1440-4124 6 Louis Appleby 7 Navneet Kapur 0000-0002-3100-3234 8 Ann John 0000-0002-5657-6995 9 65583__30495__5b233284e614404d8cfcecad142de789.pdf 65583.VoR.pdf 2024-05-31T13:00:37.3263287 Output 490758 application/pdf Version of Record true © The Author(s), 2024. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence. true eng http://creativecommons.org/licenses/by/4.0/ 235
title Contacts with primary and secondary healthcare before suicide by those under the care of mental health services: case–control, whole-population-based study using person-level linked routine data in Wales, UK during 2000–2015
spellingShingle Contacts with primary and secondary healthcare before suicide by those under the care of mental health services: case–control, whole-population-based study using person-level linked routine data in Wales, UK during 2000–2015
Marcos del Pozo Banos
Sze Chim Lee
Olivier Rouquette
Keith Lloyd
Ann John
title_short Contacts with primary and secondary healthcare before suicide by those under the care of mental health services: case–control, whole-population-based study using person-level linked routine data in Wales, UK during 2000–2015
title_full Contacts with primary and secondary healthcare before suicide by those under the care of mental health services: case–control, whole-population-based study using person-level linked routine data in Wales, UK during 2000–2015
title_fullStr Contacts with primary and secondary healthcare before suicide by those under the care of mental health services: case–control, whole-population-based study using person-level linked routine data in Wales, UK during 2000–2015
title_full_unstemmed Contacts with primary and secondary healthcare before suicide by those under the care of mental health services: case–control, whole-population-based study using person-level linked routine data in Wales, UK during 2000–2015
title_sort Contacts with primary and secondary healthcare before suicide by those under the care of mental health services: case–control, whole-population-based study using person-level linked routine data in Wales, UK during 2000–2015
author_id_str_mv f141785b1c0ab9efe45665d35c081b84
10628af4988d624b49c4de7bd78b4694
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ed8a9c37bd7b7235b762d941ef18ee55
author_id_fullname_str_mv f141785b1c0ab9efe45665d35c081b84_***_Marcos del Pozo Banos
10628af4988d624b49c4de7bd78b4694_***_Sze Chim Lee
0e502db88ea48ce6b053ed0eef9a54ce_***_Olivier Rouquette
a13aaa0df9045c205e82ed3b95d18c10_***_Keith Lloyd
ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
author Marcos del Pozo Banos
Sze Chim Lee
Olivier Rouquette
Keith Lloyd
Ann John
author2 Marcos del Pozo Banos
Cathryn Rodway
Sze Chim Lee
Olivier Rouquette
Saied Ibrahim
Keith Lloyd
Louis Appleby
Navneet Kapur
Ann John
format Journal article
container_title BJPsych Open
container_volume 10
container_issue 3
publishDate 2024
institution Swansea University
issn 2056-4724
doi_str_mv 10.1192/bjo.2024.23
publisher Royal College of Psychiatrists
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description BackgroundPeople under mental health (MH) services’ care are at increased risk of suicide. Existing studies are small in scale and lack comparisons.AimTo identify opportunities for suicide prevention and underpinning data enhancement in people with recent contact with MH services.MethodPopulation-based study of all who died by suicide in the year following a MH services contact in Wales, 2001–2015 (cases), paired with similar patients who did not die by suicide (controls). We linked the National Confidential Inquiry into Suicide and Safety in Mental Health and the Suicide Information Database - Cymru with primary and secondary healthcare records. We present odds ratios and 95% confidence intervals (OR [95% CI]) of conditional logistic regression.ResultsWe matched 1,031 cases with 5,155 controls. In the year before their death, 98.3% of cases were in contact with healthcare services, and 28.5% presented with self-harm. Cases had more emergency department contacts (OR=2.4 [2.1-2.7]) and emergency hospital admissions (OR=1.5 [1.4-1.7]), but less primary care contacts (OR=0.7 [0.6-0.9]) and outpatient appointments (OR=0.2 [0.2-0.3]) than controls. ORs were larger in females than males for injury and poisoning (OR=3.3 [2.5-4.5] vs 2.6 [2.1-3.1]).ConclusionWe may be missing existing opportunities to intervene, particularly in emergency departments and hospital admissions with self-harm presentations, and with unattributed self-harm, especially in females. Prevention efforts should focus on strengthening routine care contacts, responding to emergency contacts, and better self-harm care. There are benefits to enhancing clinical audit systems with routinely collected data for data completeness, breadth, and depth
published_date 2024-05-10T13:02:17Z
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