Primary care consultation patterns before suicide: a nationally representative case-control study.

BACKGROUND: Consultation with primary healthcare professionals may provide an opportunity to identify patients at higher suicide risk. AIM: To explore primary care consultation patterns in the 5 years before suicide to identify suicide high-risk groups and common reasons for consulting. DESIGN AND SETTING: This was a case-control study using electronic health records from England, 2001 to 2019. METHOD: An analysis was undertaken of 14 515 patients aged ≥15 years who died by suicide and up to 40 matched live controls per person who died by suicide (n = 580 159), (N = 594 674). RESULTS: Frequent consultations (>1 per month in the final year) were associated with increased suicide risk (age- and sex -adjusted odds ratio [OR] 5.88, 95% confidence interval [CI] = 5.47 to 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 (>1 per month in the final year) demonstrating higher suicide risk compared with their counterparts who consulted once: females (adjusted OR 9.50, 95% CI = 7.82 to 11.54), patients aged 15-<45 years (adjusted OR 8.08, 95% CI = 7.29 to 8.96), patients experiencing less socioeconomic deprivation (adjusted OR 6.56, 95% CI = 5.77 to 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 most common reasons for which patients who died by suicide 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.

The association between living alone, loneliness and suicide mortality and effect modification by age: A case:control study.

BACKGROUND: Social isolation is a potentially reversible risk factor for suicide. METHODS: A matched case control study design was used. The study population was from England and identified from an electronic primary case database with linkage to a secondary care database and Office for National Statistics mortality data. Cases were individuals who had been recorded as dying by suicide. Controls were randomly selected, matched by primary care centre and date of suicide mortality. RESULTS: Data were available from 14,515 cases who died from suicide and 580,159 controls. After adjustment for age and sex, the risk of suicide in individuals who had previously been reported to be either living alone or suffering loneliness was increased (Odds ratio OR 4.9; 95 % confidence intervals CI: 4.4 to 5.5). Age affected the level of this risk, with individuals aged 15 to 34 years who were lonely or lived alone having a much higher risk of suicide (OR 16.4; 95 % CI: 8.7 to 31.1). LIMITATIONS: We can demonstrate an association between loneliness and living alone, but this may not be a causal effect. The conclusions may not be generalisable to societies outside the UK. CONCLUSIONS: Loneliness and social isolation are associated with an approximately five-fold increase in risk of mortality from suicide, which was substantially higher in younger adults. These represent potentially reversible risk factors for suicide mortality and may also help identify individuals who are at a higher risk of suicide.

Evaluation of common prescription analgesics and adjuvant analgesics as markers of suicide risk: a longitudinal population-based study in England.

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.

Risk of Suicide After Dementia Diagnosis.

Importance: Patients with dementia may be at an increased suicide risk. Identifying groups at greatest risk of suicide would support targeted risk reduction efforts by clinical dementia services. Objectives: To examine the association between a dementia diagnosis and suicide risk in the general population and to identify high-risk subgroups. Design, Setting, and Participants: This was a population-based case-control study in England conducted from January 1, 2001, through December 31, 2019. Data were obtained from multiple linked electronic records from primary care, secondary care, and the Office for National Statistics. Included participants were all patients 15 years or older and registered in the Office for National Statistics in England with a death coded as suicide or open verdict from 2001 to 2019. Up to 40 live control participants per suicide case were randomly matched on primary care practice and suicide date. Exposures: Patients with codes referring to a dementia diagnosis were identified in primary care and secondary care databases. Main Outcomes and Measures: Odds ratios (ORs) were estimated using conditional logistic regression and adjusted for sex and age at suicide/index date. Results: From the total sample of 594 674 patients, 580 159 (97.6%) were controls (median [IQR] age at death, 81.6[72.0-88.4] years; 289 769 male patients [50.0%]), and 14 515 (2.4%) died by suicide (median [IQR] age at death, 47.4 [36.0-59.7] years; 10 850 male patients [74.8%]). Among those who died by suicide, 95 patients (1.9%) had a recorded dementia diagnosis (median [IQR] age at death, 79.5 [67.1-85.5] years; median [IQR] duration of follow-up, 2.3 [1.0-4.4] years). There was no overall significant association between a dementia diagnosis and suicide risk (adjusted OR, 1.05; 95% CI, 0.85-1.29). However, suicide risk was significantly increased in patients diagnosed with dementia before age 65 years (adjusted OR, 2.82; 95% CI, 1.84-4.33), in the first 3 months after diagnosis (adjusted OR, 2.47; 95% CI, 1.49-4.09), and in patients with dementia and psychiatric comorbidity (adjusted OR, 1.52; 95% CI, 1.21-1.93). In patients younger than 65 years and within 3 months of diagnosis, suicide risk was 6.69 times (95% CI, 1.49-30.12) higher than in patients without dementia. Conclusions and Relevance: Diagnostic and management services for dementia, in both primary and secondary care settings, should target suicide risk assessment to the identified high-risk groups.

Risk of mortality from suicide in patients with Huntington's disease is increased compared to the general population in England.

OBJECTIVE: To examine the relative risk of suicide mortality in patients with Huntington's disease (HD). METHODS: A case-control study design was used. We used linked electronic records from primary care, secondary care and Office for National Statistics from England from 2001 through 2019. Controls were matched to cases by general practice and suicide date. Odds ratios (ORs) were adjusted for gender and age at suicide/index date. RESULTS: Data were available for 594,674 individuals. Patients with HD who died from suicide were significantly younger at time of death than patients with HD who died from causes other than suicide (p < 0.001). The adjusted OR for HD was 9.2 (95% confidence intervals, CI 4.9-17.4) compared to those without HD. The increase in risk was higher amongst the younger age group who were ≤ 45.8 years at suicide/index date (OR 54.5, 95% CI 10.8-276.1). CONCLUSION: The markedly elevated suicide risk in patients with HD suggests that implementation of suicide risk assessment may improve survival in individuals with these diseases, especially in younger patients.

Ethnicity and suicide risk: A population-based study from England.

Using multiple linked electronic health databases, we conducted a large case-control study in England from 2001 through 2019 to examine the association between ethnicity and suicide risk. Asian, Black and Other ethnic groups had a significantly lower suicide risk compared to White individuals, with those of Asian ethnicity having the lowest risk (Odds Ratio 0.53, 95% Confidence Interval 0.47-0.60). This ethnicity related suicide risk was significantly altered by socio-demographic characteristics. These factors can inform the assessment and stratification of suicide risk, as well as the targeting of public health measures designed to reduce suicide incidence.

Global differences in geography, religion and other societal factors are associated with sex differences in mortality from suicide: An ecological study of 182 countries.

BACKGROUND: Over 800,000 individuals die as a consequence of suicide annually, and almost two thirds of these deaths are in males. This analysis aimed to explore sex differences in global suicide rates with regards to geographic location, religion and other societal factors. METHODS: Data on sex-specific suicide rates were collated for 182 countries in 2015. The exposures of interest were geographical location, majority religion, life expectancy, total fertility rate (TFR), literacy percentage, gender development index and gross domestic product. RESULTS: Both continent and predominant religion were strongly associated with the male:female ratio for deaths from suicide (p < 0.001 for both variables). The highest male:female suicide ratio was observed in the Americas with a median value of 4.0 (interquartile range IQR: 3.0-5.0) and the lowest gender suicide ratios were observed in Africa (2.7, IQR: 2.4-3.3) and Asia (2.7, IQR: 1.8-3.9). The predominantly Christian countries revealed the highest male:female suicide ratio (3.3, IQR: 2.7-4.4) whereas the predominantly Hindu countries revealed the lowest (1.3, IQR 1.3-3.8). The following variables were all positively associated with male:female ratio of suicide mortality: Life expectancy (Spearman's correlation coefficient r = +0.21, p = 0.004), GDP per capita (r = +0.26, p = 0.003), literacy percentage (r = +0.46, p < 0.0001), and Gender Development Index (r = +0.56, p < 0.0001). TFR was negatively associated with sex suicide ratio (-0.30, p < 0.0001). CONCLUSION: There are significant differences between male and female suicide rates across continents and cultures. Markers of societal development are associated with a higher proportion of male suicides compared to females.