Background: Previous studies have reported that many suicide victims have had contact with their physicians a week or month prior to their suicide.
Aims: To assess the date of the last appointment (and complaint) of suicide victims in the Škofja Loka region within Slovenia.
Method: We included all suicide victims in the region in the period 1993—2003. Each of the cases was assigned the closest control in terms of age and gender. Medical death certificates served as a source of demographic data information and information about suicide method. From personal medical records we obtained the date of the last appointment (and the complaint) with the primary care physician. The same was done for the control group. The groups were compared for their last appointment with their physician (date and complaint).
Results: Thirty out of 77 suicide victims visited their physician in the last month before suicide (14/77 in the last week); only 16/77 controls did so before the index day (3/77 in the last week). In 30% of suicide victims, the reason for the last visit was mental health problems (only 3% in the control group).
Conclusion: The results emphasize the important role of primary care physicians in suicide prevention.
Andersen, U.A., Andersen, M., Rosholm, J.U. & Gram, L.F. ( 2000) Contacts to the health care system prior to suicide: A comprehensive analysis using registers for general and psychiatric hospital admissions, contacts to general practitioners and practising specialists and drug prescriptions. Acta Psychiatrica Scandinavica, 102, 126-136.
2.
Cedereke, M., Monti, K. & Ojehagen, A. ( 2002) A telephone contact with patients in the year after a suicide attempt: Does it affect treatment attendance and outcome? A randomized controlled study. European Journal of Psychiatry, 17, 82-91.
3.
Gilbody, S., Whitty, P., Grimshaw, J. & Thomas, R. ( 2003) Educational and organizational interventions to improve the management of depression in primary care. Journal of the American Medical Association, 289(23), 3145-3151.
4.
Guthrie, E., Kapur, N., Mackway-Jones, K., Chew-Graham, C., Moorey, J., Mendel, E., Marino-Francis, F., Sanderson, S., Turpin, C., Boddy, G. & Tomenson, B. ( 2001) Randomized controlled trial of brief psychological intervention after deliberate self-poisoning, British Medical Journal, 323, 135-138.
5.
Haste, F., Charlton, R. & Jenkins, R. ( 1998) Potential for suicide prevention in primary care? An analysis of factors associated with suicide. British Journal of General Practice, 48(436), 1759-1763.
6.
Henriksson, S. & Isacsson, G. ( 2006) Increased antidepressant use and fewer suicides in Jamtland county, Sweden, after a primary care educational programme on the treatment of depression. Acta Psychiatrica Scandinavica , 114(3), 159-167
7.
Hunkeler, E.M., Meresman, J.F., Hargreaves, W.A., Fireman, B., Berman, W.H., Kirsch, A.J., Groebe, J., Hurt, S.W., Braden, P., Getzell, M., Feigenbaum, P.A., Peng, T. & Salzer, M. ( 2000) Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care. Archives of Family Medicine, 9, 700-708.
8.
Kelly, C. ( 1998) The effects of depression awareness seminars on general practitioners’ knowledge of depressive illness. Ulster Medical Journal, 67, 33-35.
9.
Lepine, J.P., Gastpar, M., Mendlewicz, J. & Tylee, A. ( 1997) Depression in the community: The first pan-European study DEPRES (Depression Research in European Society). International Clinical Psychopharmacology, 12, 19-29.
10.
Luoma, J.B., Martin, C.E. & Pearson, J.L. ( 2002) Contact with mental health and primary care providers before suicide: A review of the evidence. American Journal of Psychiatry, 159, 909-916.
11.
Mann, J.J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., Hegerl, U., Lonnqvist, J., Malone, K., Marusic, A., Mehlum, L., Patton, G., Phillips, M., Rutz, W., Rihmer, Z., Schmidtke, A., Shaffer, D., Silverman, M., Takahashi, Y., Varnik, A., Wasserman, D., Yip, P. & Hendin, H. ( 2005) Suicide prevention strategies. Journal of the American Medical Association, 294(16), 2064-2074.
12.
Marušič, A. ( 1999) Suicide in Slovenia: Lesson for cross-cultural psychiatry . International Review of Psychiatry, 11, 212-218.
13.
Marušič, A. ( 1998) Suicide mortality in Slovenia: Regional variation . Crisis, 19, 159-167.
14.
Marušič, A., Roškar, S., Dernovšek, M.Z., Groleger, U., Janet, E., Rupnik, I., Konec Juričič, N. , Leser, I., Šešok , J., Tavčar, R., Vengust Vidmar, M. & Zorko, M. ( 2004) An attempt of suicide prevention: The Slovene Gotland Study. In Final Programme & Abstract Book: Research - Prevention - Treatment - Hope. Copenhagen: ICS.
15.
Matthews, K., Milne, S. & Ashcroft, G.W. ( 1994) Role of doctors in the prevention of suicide: The final consultation. British Journal of General Practice, 44(385), 345-348.
16.
Mayou, R.A. ( 1997) Depression and types of physical disorder and treatment . In Depression and Physical Illness (eds M.M. Robertson & C.L.E. Katona), pp. 2-38. Chichester: John Wiley.
17.
Milton, J., Ferguson, B. & Mills, T. ( 1999) Risk assesment and suicide prevention in primary care . Crisis, 20(4), 171-177.
18.
Motto, J.A. & Bostrom, A.G. ( 2001) A randomized controlled trial of post-crisis suicide prevention . Psychiatric Services, 52, 828-833.
19.
Murphy, G.E. ( 1975) The physician’s responsibility for suicide. II. Errors of omission. Annals of Internal Medicine, 82(3), 305-309.
20.
Pignone, M.P., Gaynes, B.N., Rushton, J.L., Burchell, C.M., Orleans, C.T., Mulrow, C.D. & Lohr, K.N. ( 2002) Screening for depression in adults: A summary of the evidence for the US Preventive Services Task Force. Annals of Internal Medicine, 136, 765-776.
21.
Pirkis, J. & Burgess, P. ( 1998) Suicide and recency of health care contacts. A systematic review. British Journal of Psychiatry, 173, 462-474.
22.
Power, K., Davies, C., Swanson, V., Gordon, D. & Carter, H. ( 1997) Case-control study of GP attendance rates by suicide cases with or without a psychiatric history. British Journal of General Practice, 47(417), 211-215.
23.
Preuss, U.W., Schuckit, M.A., Smith, T.L., Danko, G.P., Bucholz, K.K., Hesselbrock, M.N., Hesselbrock, V. & Kramer, J.R. ( 2003) Predictors and correlates of suicide attempts over five years in 1,237 alcohol-dependent men and women. American Journal Psychiatry, 160, 56-63.
24.
Rihmer, Z., Belso, N. & Kalmar, S. ( 2003) Antidepressants and suicide prevention in Hungary . Acta Psychiatrica Scandinavica, 103, 238-239.
25.
Simon, G.E., Ludman, E.J., Tutty, S., Operskalski, B. & Von Korff, M. ( 2004) Telephone psychotherapy and telephone care management for primary care patients starting antidepressant treatment. Journal of the American Medical Association, 292, 935-942.
26.
Stanistreet, D., Gabbay, M.B., Jeffrey, V. & Taylor, S. ( 2004) The role of primary care in the prevention of suicide and accidental death among young men: An epidemiological study. British Journal of General Practice, 54(501), 254-258.
27.
Szanto, K., Kalmar, S., Hendin, H., Rihmer, Z. & Mann, J.J. ( 2007) A suicide prevention programme in a region with a very high suicide rate. Archives of General Psychiatry, 64(8), 914-920.
28.
Windle, M. ( 2004) Suicidal behaviours and alcohol use among adolescents: A developmental psychopathology perspective. Alcoholism Clinical and Experimental Research, 5, 29S-37S.
