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Research article:

Suicide risk linked with clinical consultation frequency, psychiatric diagnoses and psychotropic medication prescribing in a national study of primary care patients

Reference:

Kirsten Windfuhr, David While, Nav Kapur, Darren M. Ashcroft, Evangelos Kontopantelis, Matthew J. Carr, Jenny Shaw, Louis Appleby, Roger T. Webb (2016) Suicide risk linked with clinical consultation frequency, psychiatric diagnoses and psychotropic medication prescribing in a national study of primary care patients. Psychological Medicine, doi:

Link to article
Abstract
Background: Little is known about the precursors of suicide risk among primary care patients. Objectives: To examine risk of suicide in relation to recent general practice consultation patterns, psychiatric diagnoses and the prescribing of multiple psychotropic drug types. Methods: Nested case-control study in the Clinical Practice Research Datalink (CPRD), England. Patients aged 16 years and older who died by suicide during 2002-2011 (N=2384) were matched on gender, age and registered practice with up to 20 living control patients (N=46,899). Results: Risk of dying by suicide was raised among general practice non-attenders, and increased sharply with rising number of clinical consultations compared with patients who consulted once only in the year preceding suicide. Markedly elevated risk was also associated with the prescribing of multiple psychotropic medication types and with having several psychiatric diagnoses, and to a lesser degree risk was also raised among patients living in more socially deprived residential areas. In a multivariable model the confounding effect of multiple psychotropic drug types largely accounted for the rising risk gradient observed with increasing clinical consultation frequency. Conclusion: A greater proportion of patients with several psychiatric diagnoses, those prescribed multiple psychotropic medication types, and those who consult at very high frequency might be considered for referral to mental health services by their general practitioners. Non-attenders are also at increased risk, which suggests that conventional models of primary care may not be effective in meeting the needs of all people in the community experiencing major psychosocial difficulties and at elevated risk of suicide.
Author for correspondence
Roger Webb
Email for correspondence
roger.webb@manchester.ac.uk

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Res38: Anxiety Download this codelist
Res38: Bipolar disorder Download this codelist
Res38: Depression Download this codelist
Res38: Eating disorder Download this codelist
Res38: Personality disorder Download this codelist
Res38: Schizophrenia spectrum Download this codelist
Res38: Anxiolitics Download this codelist
Res38: Atypical APDs Download this codelist
Res38: Benzodiazepines Download this codelist
Res38: Depot APDs Download this codelist
Res38: Lithium and other mood stabilisers Download this codelist
Res38: Opioid analgesics Download this codelist
Res38: Other ADDs Download this codelist
Res38: SSRI ADDs Download this codelist
Res38: Tricyclic ADDs Download this codelist
Res38: Typical APDs Download this codelist

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