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Last general practitioner consultation during the final month of life: a national medical record review of suicides in Sweden

Palmqvist Öberg, Nina Margareta LU ; Lindström, Sara LU orcid ; Bergqvist, Erik LU orcid ; Ehnvall, Anna LU ; Sellin, Tabita ; Stefenson, Anne ; Sunnqvist, Charlotta LU ; Waern, Margda and Westrin, Åsa LU (2024) In BMC Primary Care
Abstract (Swedish)
Objectives
Individuals who die by suicide often consult their general practitioners (GPs) in their final weeks of life. The aim of this study was to gain a deeper knowledge of the clinical characteristics and GP assessments and treatments among individuals who consulted their GPs during the month preceding suicide. Further, we compared these features in those with and without contact with psychiatric services (PC and NPC, respectively) during the two years that preceded the suicide.

Design
A nationwide retrospective explorative study investigating medical records.

Setting
Primary care in Sweden.

Participants
Individuals who died by suicide in Sweden in 2015 with a GP visit within 30 days of... (More)
Objectives
Individuals who die by suicide often consult their general practitioners (GPs) in their final weeks of life. The aim of this study was to gain a deeper knowledge of the clinical characteristics and GP assessments and treatments among individuals who consulted their GPs during the month preceding suicide. Further, we compared these features in those with and without contact with psychiatric services (PC and NPC, respectively) during the two years that preceded the suicide.

Design
A nationwide retrospective explorative study investigating medical records.

Setting
Primary care in Sweden.

Participants
Individuals who died by suicide in Sweden in 2015 with a GP visit within 30 days of death.

Results
The study cohort corresponds to one fifth (n = 238) of all suicides that occurred in Sweden in 2015 (n = 1179), representing all those with available primary care records showing contact with a GP during the final 30 days of life (NPC: n = 125; PC: n = 113). The mean age was 58 years ± 19. Patients in the NPC group were older (NPC: 63 years ± 19 vs. PC: 53 years ± 18, p < 0.0001) and presented psychiatric symptoms less often (NPC: 50% vs. PC: 67%, p < 0.006). Somatic symptoms were as common as psychiatric symptoms for the whole sample, being present in more than half of individuals. Suicide risk was noted in only 6% of all individuals. Referral to psychiatric services occurred in 14%, less commonly for the NPC group (NPC: 6% vs. PC: 22%, p < 0.001). Cardiovascular or respiratory symptoms were noted in 19%, more often in the NPC group (NPC: 30% vs. PC: 6%, p < 0.001), as were diagnoses involving the circulatory system (all 10%, NPC:14% vs. PC: 5%, p < 0.020).

Conclusion
A high level of somatic symptoms was observed in primary care patients both with and without psychiatric contact, and this might have influenced GPs’ management decisions. Psychiatric symptoms were noted in two thirds of those with psychiatric contact but only half of those without. While GPs noted psychiatric symptoms in over half of all individuals included in the study, they seldom noted suicide risk. These findings highlight the need for increased attention to psychiatric symptoms and suicide risk assessment, particularly among middle-aged and older individuals presenting with somatic symptoms.

Strengths and limitations of this study
The National Cause of Death Register has excellent coverage of suicide deaths and access to medical records was very good. The medical record review provided detailed information regarding primary care utilization before death by suicide. Because of the lack of statistical power, due to the limited number of persons with GP contact during the last month of life, we chose not to correct for multiple comparisons. Our study approach did not capture the reasons behind GPs’ documentation of elevated suicide risk. No systematic inter-rater reliability (IRR) testing was made, however, reviewers received training and continuous support from the research group. (Less)
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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
BMC Primary Care
article number
256
publisher
BioMed Central (BMC)
external identifiers
  • pmid:39010009
  • scopus:85198661792
ISSN
2731-4553
DOI
10.1186/s12875-024-02498-y
language
Swedish
LU publication?
yes
id
82dad589-cbee-4a33-9ca7-f327a8da4445
date added to LUP
2024-08-07 14:45:15
date last changed
2024-08-08 08:55:46
@article{82dad589-cbee-4a33-9ca7-f327a8da4445,
  abstract     = {{Objectives<br/>Individuals who die by suicide often consult their general practitioners (GPs) in their final weeks of life. The aim of this study was to gain a deeper knowledge of the clinical characteristics and GP assessments and treatments among individuals who consulted their GPs during the month preceding suicide. Further, we compared these features in those with and without contact with psychiatric services (PC and NPC, respectively) during the two years that preceded the suicide.<br/><br/>Design<br/>A nationwide retrospective explorative study investigating medical records.<br/><br/>Setting<br/>Primary care in Sweden.<br/><br/>Participants<br/>Individuals who died by suicide in Sweden in 2015 with a GP visit within 30 days of death.<br/><br/>Results<br/>The study cohort corresponds to one fifth (n = 238) of all suicides that occurred in Sweden in 2015 (n = 1179), representing all those with available primary care records showing contact with a GP during the final 30 days of life (NPC: n = 125; PC: n = 113). The mean age was 58 years ± 19. Patients in the NPC group were older (NPC: 63 years ± 19 vs. PC: 53 years ± 18, p &lt; 0.0001) and presented psychiatric symptoms less often (NPC: 50% vs. PC: 67%, p &lt; 0.006). Somatic symptoms were as common as psychiatric symptoms for the whole sample, being present in more than half of individuals. Suicide risk was noted in only 6% of all individuals. Referral to psychiatric services occurred in 14%, less commonly for the NPC group (NPC: 6% vs. PC: 22%, p &lt; 0.001). Cardiovascular or respiratory symptoms were noted in 19%, more often in the NPC group (NPC: 30% vs. PC: 6%, p &lt; 0.001), as were diagnoses involving the circulatory system (all 10%, NPC:14% vs. PC: 5%, p &lt; 0.020).<br/><br/>Conclusion<br/>A high level of somatic symptoms was observed in primary care patients both with and without psychiatric contact, and this might have influenced GPs’ management decisions. Psychiatric symptoms were noted in two thirds of those with psychiatric contact but only half of those without. While GPs noted psychiatric symptoms in over half of all individuals included in the study, they seldom noted suicide risk. These findings highlight the need for increased attention to psychiatric symptoms and suicide risk assessment, particularly among middle-aged and older individuals presenting with somatic symptoms.<br/><br/>Strengths and limitations of this study<br/>The National Cause of Death Register has excellent coverage of suicide deaths and access to medical records was very good. The medical record review provided detailed information regarding primary care utilization before death by suicide. Because of the lack of statistical power, due to the limited number of persons with GP contact during the last month of life, we chose not to correct for multiple comparisons. Our study approach did not capture the reasons behind GPs’ documentation of elevated suicide risk. No systematic inter-rater reliability (IRR) testing was made, however, reviewers received training and continuous support from the research group.}},
  author       = {{Palmqvist Öberg, Nina Margareta and Lindström, Sara and Bergqvist, Erik and Ehnvall, Anna and Sellin, Tabita and Stefenson, Anne and Sunnqvist, Charlotta and Waern, Margda and Westrin, Åsa}},
  issn         = {{2731-4553}},
  language     = {{swe}},
  month        = {{07}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{BMC Primary Care}},
  title        = {{Last general practitioner consultation during the final month of life: a national medical record review of suicides in Sweden}},
  url          = {{http://dx.doi.org/10.1186/s12875-024-02498-y}},
  doi          = {{10.1186/s12875-024-02498-y}},
  year         = {{2024}},
}