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Suicide risk linked with clinical consultation frequency, psychiatric diagnoses and psychotropic medication prescribing in a national study of primary-care patients

Published online by Cambridge University Press:  21 September 2016

K. Windfuhr ,
D. While ,
N. Kapur ,
D. M. Ashcroft ,
E. Kontopantelis ,
M. J. Carr ,
J. Shaw ,
L. Appleby  and
R. T. Webb
K. Windfuhr
Affiliation:
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, University of Manchester, UK Centre for Mental Health and Safety, University of Manchester, UK
D. While
Affiliation:
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, University of Manchester, UK Centre for Mental Health and Safety, University of Manchester, UK
N. Kapur
Affiliation:
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, University of Manchester, UK Centre for Mental Health and Safety, University of Manchester, UK
D. M. Ashcroft
Affiliation:
Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School and NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, UK
E. Kontopantelis
Affiliation:
Centre for Health Informatics, Institute of Population Health, University of Manchester, UK
M. J. Carr
Affiliation:
Centre for Mental Health and Safety, University of Manchester, UK
J. Shaw
Affiliation:
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, University of Manchester, UK Centre for Mental Health and Safety, University of Manchester, UK
L. Appleby
Affiliation:
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, University of Manchester, UK Centre for Mental Health and Safety, University of Manchester, UK
R. T. Webb*
Affiliation:
Centre for Mental Health and Safety, University of Manchester, UK
*
*Address for correspondence: Dr R. Webb, Centre for Mental Health & Safety, Institute of Brain, Behaviour & Mental Healthm, Room 2.311, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK. (Email: roger.webb@manchester.ac.uk)
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Abstract

Background

Little is known about the precursors of suicide risk among primary-care patients. This study aimed to examine suicide risk in relation to patterns of clinical consultation, psychotropic drug prescribing, and psychiatric diagnoses.

Method

Nested case-control study in the Clinical Practice Research Datalink (CPRD), England. Patients aged ⩾16 years who died by suicide during 2002–2011 (N = 2384) were matched on gender, age and practice with up to 20 living control patients (N = 46 899).

Results

Risk was raised among non-consulting patients, and increased sharply with rising number of consultations in the preceding year [⩾12 consultations v. 1: unadjusted odds ratio (OR) 6.0, 95% confidence interval (CI) 4.9–7.3]. Markedly elevated risk was also associated with the prescribing of multiple psychotropic medication types (⩾5 types v. 0: OR 62.6, CI 44.3–88.4) and with having several psychiatric diagnoses (⩾4 diagnoses v. 0: OR 31.1, CI 19.3–50.1). Risk was also raised among patients living in more socially deprived localities. The confounding effect of multiple psychotropic drug types largely accounted for the rising risk gradient observed with increasing consultation frequency.

Conclusions

A greater proportion of patients with several psychiatric diagnoses, those prescribed multiple psychotropic medication types, and those who consult at very high frequency might be considered for referral to mental health services by their general practitioners. Non-consulters are also at increased risk, which suggests that conventional models of primary care may not be effective in meeting the needs of all people in the community experiencing major psychosocial difficulties.

Keywords

Epidemiologymental diseaseprimary carepsychosocial factorssuicide
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 16 , December 2016 , pp. 3407 - 3417
Copyright
Copyright © Cambridge University Press 2016 

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