Article Figures & Data
Tables
- Table 1. Demographic and clinical characteristics of people who died by suicide in the first 2 weeks after discharge (N = 93)
Characteristic n % Sex Male 69 74.2 Female 24 25.8 Age at discharge, years 18–34 9 9.7 35–64 67 72.0 ≥65 17 18.3 Primary diagnosis at dischargea Schizophrenia 6 6.5 Bipolar disorder — — Depression 23 24.7 Anxiety, adjustment, and related disorders 30 32.3 Substance misuse 8 8.6 Personality disorders — — All other codes 26 28.0 ≥1 comorbidities at baseline 21 22.6 Length of stay, days 0–7 41 44.1 8–29 30 32.3 ≥30 22 23.7 Consultation in primary care post-discharge 39 41.9 Psychotropic medication types prescribed 0 65 69.9 1 9 9.7 2 11 11.8 ≥3 8 8.6 aFigures for bipolar disorder and personality disorders total fewer than five people each and have therefore been included in ‘all other codes’
- Table 2. Demographic and clinical characteristics of people who died by suicide after 2 weeks but within 1 year of discharge and their corresponding controls who did not die during the equivalent period
Cases, n = 520 Controls, n = 8354 Characteristic n % n % Sex Male 348 66.9 5601 67.0 Female 172 33.1 2753 33.0 Age at discharge, years 18–34 126 24.2 2080 24.9 35–64 313 60.2 5165 61.8 ≥65 81 15.6 1109 13.3 Primary diagnosis at discharge Schizophrenia 51 9.8 1422 17.0 Bipolar disorder 34 6.5 545 6.5 Depression 162 31.2 1689 20.2 Anxiety, adjustment, and related disorders 87 16.7 822 9.8 Substance misuse 52 10.0 1472 17.6 Personality disorder 26 5.0 223 2.7 All other codes 108 20.8 2181 26.1 ≥1 comorbidities at baseline 99 19.0 1759 21.1 Length of stay, days 0–7 148 28.5 2304 27.6 8–29 222 42.7 3327 39.8 30–89 126 24.2 2016 24.1 ≥90 24 4.6 705 8.4 Number of psychotropic medication types prescribed 0 114 21.9 2376 28.4 1 95 18.3 2234 26.7 2 123 23.7 1950 23.3 ≥3 188 36.2 1794 21.5 Tricyclic antidepressants prescribed 48 9.2 499 6.0 Opioids prescribed 32 6.2 420 5.0 Gabapentinoids prescribed 26 5.0 240 2.9 Timing of first consultation Within 2 weeks 268 51.5 4332 51.9 After 2 weeks 156 30.0 2365 28.3 No consultation 96 18.5 1657 19.8 Frequency of consultations Low 172 33.1 3275 39.2 Medium 159 30.6 2595 31.1 High 189 36.3 2484 29.7 Consultation in the week before death by suicide 164 31.5 1702 20.4 Readmission to inpatient psychiatric care 165 31.7 1147 13.7 Median IQR Median IQR Consultations (all staff types) 4 1-8 3 1–7 Consultations with a GP 2 0–6 2 0–5 Face-to-face consultation 3 1-7 3 1–6 Telephone or online consultation 0 0–1 0 0–1 Died in first 2 weeks Died during rest of year Informational continuity n % n % Some evidence of discharge in record 16 17.2 221 42.5 Specific discharge summary received 10 10.8 157 30.2 Proportion received in the first 7 days 123 23.7 - Table 4. Unadjusted and adjusted models of primary care use after discharge for those who died by suicide (n = 520) compared with their discharged counterparts (n = 8354)
Unadjusted Fully adjusteda Characteristic OR 95% CI P value AOR 95% CI P value Consultation frequency Low 1 1 Medium 1.14 0.91 to 1.43 0.25 1.15 0.85 to 1.57 0.36 High 1.44 1.15 to 1.79 0.001 1.17 0.84 to 1.64 0.36 Timing of first consultation Within 2 weeks 1.04 0.81 to 1.34 0.78 0.61 0.42 to 0.89 0.01 After 2 weeks 1.09 0.82 to 1.44 0.55 0.71 0.50 to 1.01 0.06 No consultation 1 1 Consultation in the week before death by suicide 1.79 1.47 to 2.18 <0.001 1.71 1.36 to 2.15 <0.001 Number of psychotropic medication types prescribed 0 1 1 1 0.89 0.67 to 1.18 0.42 0.91 0.67 to 1.24 0.55 2 1.32 1.01 to 1.73 0.04 1.20 0.89 to 1.61 0.24 ≥3 2.31 1.78 to 2.98 <0.001 1.73 1.28 to 2.33 <0.001 Tricyclic antidepressants prescribed 1.63 1.19 to 2.24 0.002 1.26 0.90 to 1.75 0.18 Readmission to inpatient psychiatric care 3.14 2.56 to 3.84 <0.001 2.93 2.38 to 3.62 <0.001 Primary diagnosis at discharge Schizophrenia 1 1 Bipolar disorder 1.70 1.08 to 2.67 0.02 1.48 0.94 to 2.35 0.09 Depression 2.64 1.90 to 3.67 <0.001 2.28 1.62 to 3.21 <0.001 Anxiety, adjustment, and related disorders 2.86 1.99 to 4.10 <0.001 2.55 1.75 to 3.72 <0.001 Substance misuse 1.02 0.68 to 1.51 0.93 1.01 0.67 to 1.52 0.97 Personality disorders 3.03 1.83 to 5.02 <0.001 2.33 1.37 to 3.95 0.002 All other codes 1.25 0.88 to 1.78 0.21 1.14 0.79 to 1.63 0.49 Length of stay, days 0–7 1 1 8–29 1.02 0.82 to 1.27 0.83 1.02 0.81 to 1.28 0.86 30–89 0.92 0.71 to 1.19 0.50 0.88 0.67 to 1.16 0.36 ≥90 0.51 0.32 to 0.79 0.003 0.58 0.37 to 0.93 0.02 ≥1 comorbidities at baseline 0.77 0.60 to 0.99 0.04 0.74 0.58 to 0.96 0.02 aAlso adjusted for source dataset. Bold values indicate statistical significance. AOR = adjusted odds ratio. OR = odds ratio.
Supplementary Data
- RM_10.3399BJGPO.2023.0165.pdf -
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.
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Primary care contact, clinical management, and suicide risk following discharge from inpatient mental health care: a case–control study
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