apr
Nina Palmqvist Öberg- Institutionen för kliniska vetenskaper, Lund
Title: Health care contacts in primary health care before suicide
Main supervisor: Åsa Westrin, Professor, Lund University
Reviewers:
Veronika Milos Nymberg, Associate Professor, Lund University
Mats Lindström, Associate Professor, Lund University
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Abstract
Background:
Suicide is often preceded by contacts with health care. In Sweden about 60% of individuals that die by suicide have at least one health care contact in the last 4 weeks. Studies have shown many of the last contacts being in primary health care. As a large proportion of individuals that go on to die by suicide are suffering from mental health problems this would give opportunities to treat them and possibly prevent their death if their suicidality was identified. Unfortunately suicidality can be missed in the large numbers of individuals visiting primary health care, especially since their mental health problems may be hidden behind physical complaints.
Research questions and methods:
The overall aim of this doctoral thesis is to gain further knowledge to help identify these patients. As a part of a larger project, medical records for the last two years for all individuals that died by suicide in Sweden 2015 were evaluated, and data from this was used in the first two studies. In the first study we investigate the last contact with a GP within 30 days before death regarding clinical characteristics, assessments and the treatment prescribed. We further assess the differences between the individuals with solely primary health care contact and those with additional psychiatric contact. The second study focuses on the clinical characteristics of the contacts of the individuals with cardiac disease to find to what extent mental health problems and suicidal ideation was noted. For the third study we plan a review of the evidence for suicide preventive measures in primary health care. To include the aspect of the lived experiences of health care personnel in primary care the fourth study is planned as qualitative analysis on focus group interviews focusing on if, and in this case how, they perceive suicidality in contacts with patients that later die by suicide.
Preliminary results:
Study I: One in five individuals that died by suicide visited a GP in the last 30 days. Individuals with no psychiatric contact were approximately 10 years older. Both groups sought help for physical symptoms even late before death, and to the almost same extent as for psychiatric symptoms. Pain was a common physical symptom, present in one third. More individuals presented psychiatric symptoms in the group with additional contacts with psychiatric services, whereas cardiovascular/ respiratory symptoms and hypertonia were more common in the group without psychiatric contact. Suicide risk was considered elevated only for a very small number. Half of all individuals had a somatic investigation done, more common in the group without psychiatric contact. Forty-five percent had an antidepressant medication.
Study II: The individuals with cardiac disease had a higher level of health care contacts than the individuals without, with more than half of them being in contact with health care in their last week. Less than a fifth of them had their last health contact with psychiatric services. Suicide risk was considered elevated only for a very small proportion also for these individuals, and for patients outside of psychiatric specialist care only around one in five had any action taken due to psychiatric problems. In individuals visiting a GP or somatic specialist physician in the last 6 months those with anxiety were more likely to be recognized with symptoms of depression/ affective diagnosis, OR 2.97 (1.277-6.891). This did not apply for risk factors such as age, male gender, physical pain or substance abuse, nor for a visit shortly before death.
Significance
The GP’s intervention might have been steered away from possible psychiatric disorders by the high level of somatic symptoms in the individuals in the first study. The high level of care contacts outside of psychiatric specialist services for the individuals with cardiac diseases in the second study also highlight the need for attention to possible mental health problems in individuals in primary health care and somatic specialist care, and if this is found the need for investigating possible suicidality.
Published studies (however not included in the thesis)
Probert-Lindström, S., Vaez, M., Fröding, E., Ehnvall, A., Sellin, T., Ambrus, L., Bergqvist, E., Palmqvist-Öberg, N., Waern, M.& Westrin, Å., Utilization of psychiatric services prior to suicide- a retrospective comparison of users with and without previous suicide attempts 2021 In: Archives of suicide research : official journal of the International Academy for Suicide Research. 27(2):401-414
Bergqvist, Erik; Probert-Lindström, Sara; Fröding, Elin; Palmqvist-Öberg, Nina; Ehnvall, Anna; Sunnqvist, Charlotta; Sellin, Tabita; Vaez, Marjan; Waern, Margda; Westrin, Åsa. Health care utilisation two years prior to suicide in Sweden: a retrospective explorative study based on medical records. In: BMC Health Services Research. 22(1); BioMed Central, 2022.
Om evenemanget
Plats:
Vallmon, Research Unit Psychiatric Clinic Baravägen 1, Lund
Kontakt:
nina_margareta [dot] palmqvist_oberg [at] med [dot] lu [dot] se