Patterns and predictors of help-seeking contacts with health services and general practitioner detection of suicidality prior to suicide: a cohort analysis of suicides occurring over a two-year period

Background: Contact with primary care and psychiatric services prior to suicide may be considerable, presenting<br/>opportunities for intervention. However, there is scant knowledge on the frequency, nature and determinants of<br/>contact.<br/>Method: Retrospective cohort study-an analysis of deaths recorded as suicide by the Northern Ireland Coroner’s<br/>Office linked with data from General Practice patient records over a 2 year period<br/>Results: Eighty-seven per cent of suicides were in contact with General Practice services in the 12 months before<br/>suicide. The frequency of contact with services was considerable, particularly among patients with a common<br/>mental disorder or substance misuse problems. A diagnosis of psychiatric problems was absent in 40 % of suicides.<br/>Excluding suicide attempts, the main predictors of a noted general practitioner concern for patient suicidality are<br/>male gender, frequency of consultations, diagnosis of mental illness and substance misuse.<br/>Conclusions: Despite widespread and frequent contact, a substantial proportion of suicidal people were<br/>undiagnosed and untreated for mental health problems. General Practitioner alertness to suicidality may be too<br/>narrowly focused.<br/>