Contacts with primary and secondary healhtcare prior to sucide: Case-control whole-population-based study using person-level linked routine data in Wales, UK, 2000-2017.

Background
Longitudinal studies of patterns of healthcare contacts in those
who die by suicide to identify those at risk are scarce.
Aims
To examine type and timing of healthcare contacts in those who
die by suicide.
Method
A population-based electronic case–control study of all who died
by suicide in Wales, 2001–2017, linking individuals’ electronic
healthcare records from general practices, emergency departments and hospitals. We used conditional logistic regression to
calculate odds ratios, adjusted for deprivation. We performed a
retrospective continuous longitudinal analysis comparing cases’
and controls’ contacts with health services.
Results
We matched 5130 cases with 25 650 controls (5 per case).
A representative cohort of 1721 cases (8605 controls) were eligible for the fully linked analysis. In the week before their death,
31.4% of cases and 15.6% of controls contacted health services.
The last point of contact was most commonly associated with
mental health and most often occurred in general practices. In
the month before their death, 16.6 and 13.0% of cases had an
emergency department contact and a hospital admission
respectively, compared with 5.5 and 4.2% of controls. At any
week in the year before their death, cases were more likely to
contact healthcare services than controls. Self-harm, mental
health and substance misuse contacts were strongly linked with
suicide risk, more so when they occurred in emergency
departments or as emergency admissions.
Conclusions
Help-seeking occurs in those at risk of suicide and escalates in
the weeks before their death. There is an opportunity to identify
and intervene through these contacts.