RESUMO
BACKGROUND: Consultation with primary health care may provide an opportunity to identify patients at higher suicide risk. AIMS: To explore primary care consultation patterns in the 5 years before suicide to identify suicide high-risk groups and common reasons for consulting. DESIGN: A case-control study in England from 2001 to 2019 using electronic health records. METHOD: Analysis of 14515 patients aged ≥15 who died by suicide and up to 40 matched live controls per case (N=594674). RESULTS: Frequent consultations (>once per month in the final year) were associated with increased suicide risk (age and sex adjusted odds ratio (OR) 5.88; 95% CI: 5.47-6.32). The associated rise in suicide risk was seen across all sociodemographic groups as well as in those with and without psychiatric comorbidities. However, specific groups were more influenced by the effect of high-frequency consultation (>once per month in the final year) demonstrating higher suicide risk compared to their counterparts who consulted once: females (adjusted OR 9.50; 95% CI: 7.82-11.54); patients aged 15 to 45 (adjusted OR 8.08; 95% CI: 7.29-8.96); patients experiencing less socioeconomic deprivation (adjusted OR 6.56; 95% CI: 5.77-7.46); and those with psychiatric conditions (adjusted OR 4.57;95% CI: 4.12 to 5.06). Medication review, depression and pain were the commonest reasons for which suicide decedents consulted in the year before death. CONCLUSION: Escalating, or more than monthly consultations are associated with increased suicide risk regardless of patients' sociodemographic characteristics and regardless of the presence (or absence) of known psychiatric illnesses.
RESUMO
Background: Analgesics prescriptions may provide a marker for identifying individuals at higher risk of suicide. In particular, awareness of which analgesics are implicated may help clinicians assess and modify risk. Method: A case-control study in England using the Clinical Practice Research Datalink (for primary care records) linked with hospital and national mortality electronic registries. We included patients aged ≥15 who died by suicide between 2001 and 2019 (N = 14,515), to whom we individually matched 580,159 controls by suicide date and general practice (N = 594,674). Odds ratios (ORs) for suicide, controlled for age and sex, were assessed using conditional logistic regression. Findings: Suicide risks were highest in those prescribed adjuvant analgesics (pregabalin, gabapentin and carbamazepine) (adjusted OR 4.07; 95% confidence intervals CI: 3.62-4.57), followed by those prescribed opioids (adjusted OR 2.01; 95% CI: 1.88-2.15) and those prescribed non-opioid analgesics (adjusted OR 1.48; 95% CI: 1.39-1.58) compared to those not prescribed these medications. By individual analgesic, the highest suicide risks were seen in patients prescribed oxycodone (adjusted OR 6.70; 95% CI: 4.49-9.37); pregabalin (adjusted OR 6.50; 95% CI: 5.41-7.81); morphine (adjusted OR 4.54; 95% CI: 3.73-5.52); and gabapentin (adjusted OR 3.12; 95% CI: 2.59-3.75). Suicide risk increased linearly with the number of analgesic prescriptions in the final year (p < 0.01 based on the likelihood ratio test), and the more different analgesics categories were prescribed in the final year (p < 0.01 based on the likelihood ratio test). Interpretation: Analgesic prescribing was associated with higher suicide risk. This is a particular issue with regard to adjuvant non-opiate analgesics. Funding: There was no funding for this study.
